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Y3 Conditions > Hypertension (secondary or essential) > Flashcards

Hypertension (secondary or essential) Flashcards

1
Q

Hypertension

Risk factors.

A

Lifestyle

  • smoking
  • alcohol
  • diet
  • weight
  • exercise

Emotional

  • anxiety
  • stress

Social deprivation

  • those from low income 30% more likely to have hypertension compared to those high income

Health

  • chronic illness
  • pregnancy
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2
Q

Hypertension

Causes of secondary hypertension.

A

renal disease
- glomerulonephritis
- renovascular disease

endocrine
- Cushing’s syndrome
- Conn’s syndrome
- phaeochromocytoma

pregnancy

iatrogenic
- corticosteroids
- oral contraception
- cocaine

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3
Q

Hypertension

How to diagnose stage 1 hypertension.

A

ABPM / HBPM

135/85-149/94

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4
Q

Hypertension

How to diagnose stage 2 hypertension.

A

ABPM / HBPM

150/95 +

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5
Q

Hypertension

A
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6
Q

Hypertension

A
  1. lifestyle advise + ACEi/ARB/CCB
  2. if that doesn’t help consider double therapy, then triple
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7
Q

Hypertension

A
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8
Q

Hypertension

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9
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10
Q

Hypertension

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11
Q

Hypertension

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12
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Hypertension

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13
Q

Hypertension

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14
Q

Hypertension

How to calculate ABPM/HBPM.

A
  • discount first day
  • calculate averages of second readings
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15
Q

Hypertension

All patients with a new diagnosis of hypertension should have the following investigations:

6

A
  • 12 lead ecg
  • urine dipstick
  • HbA1c
  • cholesterol
  • U&Es
  • fundoscopy
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16
Q

Hypertension

Why should a pt newly diagnosed with hypertension have an ecg?

A

assess cardiac function → detect left ventricular hypertrophy (LVH) → ?target organ damage

17
Q

Hypertension

What would an ECG show with LVH?

A

tall R wave, deep S in V1 or V2, inverted T waves in V5 and V6, left axis deviation, QRS may be prolonged

18
Q

Hypertension

What do we look for in a urine dipstick of a pt with newly diagnosed hypertension?
What would those findings imply?

3

A
  • Glucosuria – concurrent diabetes?
  • Haemoturia – renal disease such as renal cell carcinoma? evidence of target organ damage?
  • Proteinuria – renal disease as a secondary cause of hypertension? evidence of target organ damage?
19
Q

Hypertension

What do we look for in the U&Es of a pt with newly diagnosed hypertension?

2

A
  • assess for chronic kidney disease which may indicate target organ damage.
  • Assessing renal function will also guide medication options when discussing management.
20
Q

Hypertension

Why do we do fundoscopy in pt with newly diagnosed hypertension?

A

presence of hypertensive retinopathy (target organ damage)

21
Q

Hypertension

How do we grade the fundoscopy findings?

A

Grade 1
- silver wiring

Grade 2
- AV nipping (where artery crosses vein, vein gets thinner)

Grade 3
- flame haemorrhage

Grade 4
- papilloedema, cotton wool spots
- no disk visible

22
Q

Hypertension

What are the BP targets:

  • Age < 80 years
  • Age ≥ 80 years
  • People with frailty or multimorbidity
A

Age < 80 years
Clinic BP <140/90 mmHg or ABPM <135/85 mmHg

Age ≥ 80 years
Clinic BP <150/90 mmHg or ABPM <145/85 mmHg

People with frailty or multimorbidity
Use clinical judgement

23
Q

Hypertension

Who should not be prescribed ACEi? (or we wary when prescribing?)

A
  • pregnany women
  • those with renal artery stenosis
24
Q

Hypertension

What are some common side effects of ACEi?

7

A
  • cough
  • hypotension
  • hyperkalaemia
  • renal injury
  • foetal injury
  • Urticaria
  • Angioedema
25
Q

Hypertension

What are some common side effects of CCB?

A
  • Ankle oedema
  • Constipation
  • Palpitations
  • Flushing
  • Headaches
26
Q

Hypertension

What are some common side effects of thiazides/thiazide-like diuretics?

A
  • Hypokalemia
  • Hyponatremia
  • Metabolic alkalosis
  • Hypercalcemia.
  • Hyperglycemia
  • Hyperuricemia.
27
Q

Hypertension

Why are ACEi contraindicated in bilateral renal artery stenosis?

A
28
Q

Hypertension

Explain the mechanism of ACEi and ARBs

A
29
Q

Hypertension

Explain the mechanism of CCBs.

What is the drug target?

A

L-type calcium channel

30
Q

Hypertension

Explain the mechanism of thiazide diuretics.

What is the drug target?

A

Sodium/chloride
cotransporter

31
Q

Hypertension

Describe this fundoscopy.

A

normal fundus

32
Q

Hypertension

What do we call this?

A

microaneurysms

33
Q

Hypertension

What do we call this?

A

dot and blot haemorrhages

34
Q

Hypertension

What do we call this?

A

cotton wool spots

35
Q

Hypertension

What do we call this?

A

Pan-retinal photocoagulation

36
Q

Hypertension

What do we call this?

A

AV nipping

37
Q

Hypertension

What do we call this appearance of a fundoscopy?

A

papilloedema

38
Q

Hypertension

What is malignant hypertension?

A

a severely elevated blood pressure of ≥180/120mmHg with a new onset or progression of end-organ failure due to vascular damage.

Y3 Conditions (55 decks)

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