Hypertension & Heart Failure Flashcards
What is the difference between primary and secondary hypertension?
Primary - no known cause, just associated risk factors.
Secondary - caused by an underlying disease e.g. Kidney disease, coarctation of the aorta, taking COCP.
What is prehypertensive hypertension?
Slight increase in BP that can be reduced by non-pharmacological measures such as increased exercise.
What is white coat syndrome?
A real phenomenon where people’s BP increases in a clinical setting.
What BP defines hypertension?
140/90mmHg.
What is malignant hypertension?
Extremely high BP that develops rapidly and is a medical emergency, causes organ damage.
If BP records differently on each arm, which measurement is used?
Higher reading.
How is stage 1 hypertension classified?
> 140/90, or >135/85 for HBPM, or >130/80 for people that have diabetes or renal disease.
How is stage 2 hypertension classified?
> 160/100, or >150/95 for HBPM
How is severe hypertension classified?
> 180 systolic or >110 diastolic.
What is isolated systolic hypertension?
When the diastolic pressure is normal <90mmHg but systolic pressure is raised - >140 is mild and >160 is moderate.
Name some non-therapeutic options to initially manage prehypertension or hypertension.
- regular exercise
- healthy/balanced diet
- reduction in stress
- reduced alcohol intake
- reduced caffeine intake
- smoking cessation
Name 2 ACEi.
Ramipril
Lisinopril
For a patient who is <55 years old and Caucasian, what is the first line hypertension treatment?
ACEi or ARB.
For a patient who is >55 or African/Caribbean, what is the first line hypertension treatment?
CCB or thiazide diuretic
Why is there no point in giving ACEi or ARBs to patients >55 or African/Caribbean origin?
As they already have low renin states and little RAAS action, therefore the ACEi or ARB would be quite ineffective.
What is the MOA of ACEi?
Limits conversion of angiotensin I to angiotensin II by inhibiting ACE, resulting in vasodilation, reduced aldosterone, reduced ADH release and reduced cell growth and proliferation.
What is the most common side effect of ACEi and why?
Persistent dry cough.
Because bradykinin is a substrate for ACE, therefore with ACEi there is increased free bradykinin.
Name 4 side effects of ACEi.
- persistent dry cough
- angioedema
- renal failure
- hyperkalaemia
Name 2 Angiotensin Receptor Blockers.
Losartan
Candesartan
What is the MOA of ARBs?
Block AT1 receptors to inhibit angiotensin II mediated vasoconstriction.
Name some side effects of ARBs.
- hyperkalaemia
- renal failure
Name a CCB from each class.
Benzothiazapines - diltiazem
Dihydropyridines - amlodipine
Phenyalkylamines - verapamil
What is the MOA of CCB in hypertension?
Block L-type Ca2+ channels found o smooth muscle of vasculature, this prevents Ca2+ influx and vasoconstriction.
What is the primary choice antihypertensive in a low renin hypertensive state?
Calcium channel blocker
Name 2 thiazide diuretics.
Bendroflumethiazide
Indapamide
What is the MOA of thiazide diuretics?
Block NCC in early CT, resulting in natriuresis and diuresis which lowers ECF volume, decreasing TPR and BP.
Why is there a risk of hypokalaemia with loop and thiazide diuretics?
Increased delivery of Na+ to distal DCT, which increases Na+ reabsorption at ENaC and increases K+ secretion.
Which drug is a statin and also a calcium channel blocker?
Simvastatin
Name a drug that can be used as an antihypertensive during pregnancy.
Labetalol (beta blocker).
Name some symptoms of heart failure.
- exercise intolerance
- breathlessness
- fatigue
- oedema
Why is heart failure known as the self-perpetuating spiral?
Baroreceptor trigger increased sympathetic drive which increases afterload, and reduced renal perfusion activates RAAS, which increases preload.
What drug is used to relieve congestive symptoms in heart failure?
Furosemide
What is refractory hyperaldosteronism/aldosterone escape? What drug is used instead?
Failure of both ACEi and ARBs to work on a patient, caused by RAAS gene polymorphism.
Spironolactone can be used instead.
What is the benefit of using beta blockers for heart failure?
Blunts sympathetic influences, slower HR leads to longer diastolic filling period, better filling and improved CO.
