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Cardiovascular System > Hypertension (pathology) > Flashcards

Hypertension (pathology) Flashcards

1
Q

What are the NICE BP values for stage 1, 2, 3 primary hypertension (clinical and ABPM daytime average)?

A 
Stage 1:
	Clinic = >140/90mmHg
	ABPM daytime = >135/85mmHg
Stage 2:
	Clinic = >160/100mmHg
	ABPM daytime = >150/95mmHg
Stage 3:
	Clinic = >180/120mmHg
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2
Q

What are different types of primary hypertension (3)?

A

Primary hypertension - no cause found
White coat hypertension - hypertension when in the clinic
Masked hypertension - hypertension normal in clinic but elevated outside of clinic

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3
Q

What does a nocturnal dip in BP indicate?

A

Better prognosis

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4
Q

What are risk factors for primary hypertension (14)?

A 
Smoking 
Diabetes mellitus 
Renal disease 
Male sex 
Hyperlipidaemia 
Previous MI/ stroke 
Left ventricular hypertrophy 
Age (decreased arterial compliance)
Salt intake 
Alcohol intake 
High BMI
Stress
Low birthweight 
African populations (salt retainers)
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5
Q

What are investigations for primary hypertension?

A
  • ABPM (ambulatory blood pressure monitoring)
    • HBPM (home blood pressure monitoring)
      Assess end organ damage:
    • ECG & echo —> LVH
    • urine analysis (proteinuria)
    • renal ultrasound
    • renal function test (creatinine, eGFR, urea)
      Quantify risk:
    • ASSIGN score
    • Q-risk
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6
Q

What is the treatment/management criteria for stage 1 hypertension?

A 
Stage 1 >135/85mmHg ABPM
Treat if <80*years old AND one of:
	- target organ damage 
	- established CVD 
	- renal disease
	- diabetes 
	- 10 year CV risk >=10%

*If >80 year old target BP >140/85mmHg

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7
Q

What is the treatment/management criteria for stage 2 hypertension?

A

ABPM >150/95mmHg = treat ANY age

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8
Q

What is the stepped treatment/management approach for hypertension in <55 y.o.? (4 steps)

A

High Renin
Step 1: ACEi/ARB (CCB or beta blocker if female in childbearing age)
Step 2: ACEi/ARB + CCB or thiazide diuretic
Step 3: ACEi/ARB +CCB + thiazide diuretic
Step 4: confirm resistant hypertension (postural hypertension, compliance) + add on therapy:
- low dose spironolactone if K+ < 4.5mmol/L
- alpha or beta blocker if K+ >4.5mmol/L

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9
Q

What is the stepped treatment/management approach for hypertension in >55 y.o. Low renin (No ACEi) + black people of African/Caribbean origin of any age? (4steps)

A

Step 1: CCB
Step 2: CCB + ACEi/ARB or thiazide diuretic
Step 3: CCB + ACEi/ARB + thiazide diuretic
Step 4: confirm resistant hypertension (postural hypertension, compliance) + add on therapy:
- low dose spironolactone if K+ < 4.5mmol/L
- alpha or beta blocker if K+ >4.5mmol/L

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10
Q

What is secondary hypertension?

A

Hypertension due to identifiable cause

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11
Q

What are causes of secondary hypertension?

A
  • Chronic renal disease (polycystic kidney, chronic pyelonephritis)
  • Renal artery disease (stenosis, fibromuscular dysplasia)
  • Endocrine disease (Cushing’s disease, Primary hyperaldosteronism, Phaeochromocytoma, acromegaly, hypo- and hyperthyroidism, Glucocorticoid remediable aldosteronism (GRA))
  • Pregnancy (pre-eclampsia, gestational hypertension)
  • Vascular (coarctation of aorta)
  • Sleep apnoea (resistant nocturnal hypertension)
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12
Q

Which drugs may induce secondary hypertension? (4)

A
  • NSAIDs
  • Combined oral contraceptive
  • Corticosteroids
  • Cocaine and other stimulants
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13
Q

What other factors may make you consider presenting hypertension is secondary hypertension?

A
  • Severe/ resistant hypertension
  • Child/ adolescent
  • Worsening of previously stable hypertension
  • Malignant hypertension- medical emergency
    No other RF and age <30
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14
Q

What investigations used to identify secondary hypertension?

A
  • Renal function and urinalysis
  • Renal imaging (US, MRI renal a.)
  • aldosterone to renin ratio (ARR)
  • 24h urine for catecholamines/metanephrines for phaeochromocytoma/paraganglioma
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15
Q

What is the treatment/management for conditions causing secondary hypertension? (Multifocal fibromuscular dysplasia, Renal artery stenosis, Renal artery stenosis, Phaeochromocytoma, Cushing’s disease)

A

Multifocal fibromuscular dysplasia:
- stent if patient young and no atheroma
Renal artery stenosis:
- no stent but standard medical therapy if older patient and atheroma
Polycystic kidney:
- remove kidney —> transplant or dialysis
Phaeochromocytoma:
- refer to endocrinology and surgery
Cushing’s disease:
- surgery, chemotherapy and regular antihypertensive therapy

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16
Q

What are the 4 hypertension in pregnancy?

A

Chronic hypertension = patient with pre-existing hypertension

Gestational hypertension = new onset hypertension but no proteinuria

Preeclampsia = rise in BP >140/90 mmHg from 20 w. gestation + proteinuria > 300 mg/24h

Eclampsia = preeclampsia + seizures

17
Q

What are the treatments/management of chronic, gestational & preeclampsia hypertension in pregnancy?

A

Chronic hypertension:
- Nifedipine MODIFIED RELEASE, Methyldopa, Labetalol, Atenolol
Gestational hypertension:
- Nifedipine MR, Methyldopa, Labetalol
Preeclampsia:
- Nifedipine MR, Methyldopa, Labetalol + IV Hydralazine or Esmolol

18
Q

Acute severe hypertension, what is a Hypertensive emergency/malignant hypertension?

A

BP>180/120mmHg AND acute target organ damage

19
Q

Acute severe hypertension, what is a Hypertensive urgency/accelerated hypertension?

A

Elevated BP (>180/120mmHg) but NO acute target organ damage

20
Q

What is the treatment/management for hypertensive emergency (in everyone apart from acute ischaemic stroke + aortic dissection)?

A
  • Hospital admission and rapid blood pressure lowering
  • Lower systolic BP by 10-20% within 1st hour then to 160/80 mmHg in next 6 hours
  • Oral medication once target BP is reached
21
Q

When would you used rapid blood pressure lowering in hypertension? What are the risks of this?

A
  • Ischaemic stroke if BP > 185/110 if received or eligible for thrombolysis
  • ischaemic BP> 220/120 mmHg if not eligible for thrombolysis
  • Aortic dissection-> lower systolic BP to 100/120 mmHg

Risk:
- If lower the BP too much in ischaemic stroke -> block flow

22
Q

What is orthostatic hypotension?

A

Blood pressure drop while shifting from lying/sitting to standing
Pressure decrease of 20 mmHg systolic and/or diastolic pressure decrease of 10 mmHg within 3 minutes of standing

23
Q

What are the risk factors for orthostatic hypotension?

A
  • Age
  • Diabetes
  • Antihypertensive drugs
  • autoimmune systemic diseases
  • neurological syndromes
  • Pure autonomic failure
  • Multiple system atrophy
  • Parkinson’s disease
24
Q

What are the treatment/management strategies for orthostatic hypotension?

A
  • Teach manoeuvres to mobilise blood from lower body or stimulate pressure receptors leading to vasoconstriction (rising on the heels or isometric handgrips)
  • Tilting the bed so patient is head up
  • Ice cold water before bed

MIDODRINE for neurogenic OH-> alpha 1 adrenoreceptor agonist

Cardiovascular System (37 decks)

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