L: Hypertension Flashcards
1
Q
High blood pressure
A
Hypertension
2
Q
It is not a disease but an important risk factor for cardiovascular complications
A
Hypertension
3
Q
It can be defined as a condition where blood pressure is elevated to an extent where clinical benefit is obtained from blood pressure
A
Hypertension
4
Q
Blood Pressure Categories:
Normal
A
< 120mmHg Systolic and < 80mmHg Diastolic
5
Q
Blood Pressure Categories:
Elevated
A
120-129mmHg Systolic and < 80mmHg Diastolic
6
Q
Blood Pressure Categories:
HBP/HTN Stage 1
A
130-139mmHg Systolic or 80-89mmHg Diastolic
7
Q
Blood Pressure Categories:
HBP/HTN Stage 2
A
140mmHg Systolic or higher or 90mmgHg Diastolic or higher
8
Q
Blood Pressure Categories:
HTNS Crisis
A
Higher than 180 and/or Higher than 120
9
Q
What are the Categories of Blood Pressure
A
Normal
Elevated
HBP/HTN Stage 1
HBP/HTN Stage 2
HTNS Crisis
10
Q
Hypertension Complications
A
- Myocardial infarction
- Stroke
- Hypertensive encephalopathy / malignant hypertension
- Dissecting aortic aneurysm
- Hypertensive nephrosclerosis
- Peripheral vascular disease
11
Q
Causes of Hypertension
Primary hypertension
A
- 90-95%
- Essential hypertension
- Etiology is unknown
- Genetic factors clearly play a part
12
Q
Causes of Hypertension
Secondary hypertension
A
- 5-10%
- Renal disease
- Endocrine disease
- Vascular causes
- Drugs (sympathomimetic amines, estrogens, cyclosporine, erythropoietin, NSAIDS, steroids)
13
Q
Categories of Causes in Hypertension
A
Primary hypertension
Secondary hypertension
14
Q
Formula for Blood Pressure
A
BP = CO ✕ TPR
15
Q
CO stands for
A
Cardiac Output
16
Q
TPR stands for
A
Total Peripheral Resistance
17
Q
In hypertensive individuals, cardiac output is ____
A
not increased
18
Q
In hypertensive individuals, high blood pressure arises as a result of _____ caused by constriction of small arterioles
A
increased total peripheral resistance
19
Q
In hypertensive individuals, high blood pressure arises as a result of increased total peripheral resistance caused by ____
A
constriction of small arterioles
20
Q
The mean blood pressure is the product of
A
cardiac output and total peripheral resistance
21
Q
Blood pressure is measured using a
A
Sphygmomanometer
22
Q
a device composed of an inflatable cuff to restrict the blood flow, and a mercury or mechanical manometer to measure the pressure
A
Sphygmomanometer
23
Q
Blood Pressure is measured by
A
Sphygmomanometer
Manual (Mercury & Aneroid)
Digital
24
Q
Hypertension itself causes ___
A
no symptoms
25
What is a present symptom in HTN
Headache
26
It is usually unclear if this is caused by hypertension or is an incidental finding
Headache
27
Hypertension may also come to light for first time when the individual suffers a
hypertension-related complication
28
hypertension-related complication example
myocardial infarction or stroke.
29
Contributing factors in HTN
* Obesity
* Excess alcohol
* Salt intake
* Lack of exercise
30
Other risks in HTN
* Smoking
* Diabetes
* Hyperlipidemia
31
It is a clinical situation in which blood pressure is very high with minimal or no symptoms, and NO signs or symptoms indicating acute organ damage
Hypertensive urgency
32
Hypertensive emergency is also known as
Malignant hypertension or accelerated
33
A high blood pressure with potentially life-threatening symptoms and signs indicative of acute impairment of one or more organ systems
Hypertensive emergency
34
Hypertensive emergency is evident in the ___, where papilloedema, hemorrhages and/or exudates may be present
optic fundus
35
Medical emergency that requires hospital admission and rapid control of BP over ___ towards normal levels
12-24 hours
36
Fatal in the absence of treatment, with a __ survival of less than 20%
1-year
37
Fatal in the absence of treatment, with a 1-year survival of __
less than 20%
38
Diagnosis: Home or ambulatory blood pressure measurements is recommended to prevent
“white coat hypertension”
39
Non-Pharmacologic Approaches: Weight loss results in reduction in BP of about __ (for overweight patients)
2.5/1.5 mmHg per kg
40
Non-Pharmacologic Approaches: Diet high in fruit and vegetables, legumes and whole grain cereal improves
Cardiovascular risk
41
Non-Pharmacologic Approaches: Reduce salt intake (aim is __ daily sodium intake)
<100 mmol
42
Non-Pharmacologic Approaches: Regular dynamic exercise for at least __ on most days
30 minutes
43
AB/CD Algorithm by
Williams et al 2004
44
Initial choice of ACE inhibitor or angiotensin
receptor blocker and β blocker as first line
therapy in younger nonblack patients (<55
years)
Treatment A/B
45
Said patients often have hypertension associated with high concentration of renin. It is therefore logical to treat them with drugs that antagonize the renin-angiotensin system
Treatment A/B
46
In treatment A/B the initial choice as first line therapy are
ACE inhibitor or angiotensin
receptor blocker and β blocker
47
Treatment A/B is suitable for
younger nonblack patients (<55
years)
48
For elderly and black patients, who tend to have hypertension associated with low renin concentration, calcium channel blockers and thiazide diuretics are recommended
Treatment C/D
49
What is the recommended medicine in the treatment C/D
calcium channel blockers and thiazide diuretics
50
Treatment C/D is suitable for
elderly and black patients
51
What happens if initial drug therapy fails
A or B is combined with C or D
52
Diuretics:
* Thiazide: Bendroflumethiazide Hydrochlorothiazide
* Loops: Furosemide
* K-Sparing: Spironolactone
53
Diuretics
Thiazide:
Bendroflumethiazide Hydrochlorothiazide
54
Diuretics
Loops:
Furosemide
55
Diuretics
K-Sparing:
Spironolactone
56
Major ADRs in Diuretics
* Hyperlipidemia
* Impotence
* Uremia
* Dehydration
* Hyperkalemia
* Gynecomastia
57
Major ADRs in Calcium Channel Blockers (Dihydropyridine)
* Flushing
* Edema
* Postural hypotension
* Headache
58
Calcium Channel Blockers (Dihydropyridine)
* Nifedipine
* Amlodipine
59
Notes: Concerns about long term metabolic effects
Diuretics
60
Notes: Cheap, effective. Efficacy proven in clinical trials.
Diuretics
61
Notes: More appropriate in older patients
Diuretics
62
Notes: for patients with cardiac failure
Diuretics
63
Notes: for resistant hypertension.
Diuretics
64
Notes: Not well tolerated (especially early in treatment)
Calcium Channel Blockers (Dihydropyridine)
65
Notes: Recent trials confirm reductions in stroke and myocardial infarction
Calcium Channel Blockers (Dihydropyridine)
66
Notes: Similar efficacy to thiazides
Calcium Channel Blockers (Dihydropyridine)
67
Notes: for elderly patients and those with ischemic heart disease or diabetes
Calcium Channel Blockers (Dihydropyridine)
68
Angiotensin Converting Enzyme (ACE) Inhibitor
* Captopril
* Enalapril
* Lisinopril
* Perindopril
* Ramipril
69
Major ADRs in Angiotensin Converting Enzyme (ACE) Inhibitor
* Cough
* Rash, taste disturbance
* Renal failure
* Angio-edema
70
Notes: More expensive
Angiotensin Converting Enzyme (ACE) Inhibitor
71
Notes: Cough very common
Angiotensin Converting Enzyme (ACE) Inhibitor
72
Notes: Appropriate for use in younger patients and those with cardiac failure or diabetes
Angiotensin Converting Enzyme (ACE) Inhibitor
73
ɑ-BLOCKERS
* Prazosin
* Doxazosin
* Terazosin
74
Major ADRs in ɑ-BLOCKERS
* Edema
* Postural hypotension
75
Notes: More expensive
ɑ-BLOCKERS
76
Notes: Adverse effects common
ɑ-BLOCKERS
77
Notes: No evidence to date of long term efficacy
ɑ-BLOCKERS
78
Notes: Less effective than thiazides at preventing heart failure and combined cardiovascular outcomes (ALLHAT study)
ɑ-BLOCKERS
79
Notes: Second-line
ɑ-BLOCKERS
80
Angiotensin Receptor Blockers (ARBS)
* Losartan
* Valsartan
* Irbesartan
81
Major ADRs in Angiotensin Receptor Blockers (ARBS)
* Renal failure
* Edema
* Headache
82
Notes: More expensive
Angiotensin Receptor Blockers (ARBS)
83
Notes: for patients in whom ACE inhibitor indicated but not tolerated due to cough
Angiotensin Receptor Blockers (ARBS)
84
Notes: More effective in preventing vascular events than atenolol in patients with left ventricular hypertrophy (LVH)
Angiotensin Receptor Blockers (ARBS)
85
Centrally Acting Vasodilators
* Methyldopa
* Moxonidine
86
Major ADRs in Centrally Acting Vasodilators
* Tiredness
* Depression
87
Notes: Poorly tolerated
Centrally Acting Vasodilators
88
Notes: Only use in severe hypertension or hypertension of pregnancy
Centrally Acting Vasodilators
89
Notes: Third line
Centrally Acting Vasodilators
90
Direct-Acting Vasodilators
* Diazoxide
* Minoxidil
* Nitroprusside
91
Major ADRs in Direct-Acting Vasodilators
* Edema
* Postural hypotension
* Headache
92
Notes: Poorly tolerated
Direct-Acting Vasodilators
93
Notes: Only use in severe hypertension
Direct-Acting Vasodilators
94
CAD Stands for
Coronary Artery Disease
95
CHD Stands for
Coronary Heart Disease
96
IHD Stands for
Ischemic Heart Disease
97
ASHD Stands for
Atherosclerotic Heart Disease
98
It is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium with oxygen and nutrients
Coronary Artery Disease
99
It refers to a variety of pathologic conditions that cause narrowing or obstruction of the coronary arteries, resulting in decreased blood supply to the myocardium
Coronary Artery Disease
100
Occurs most often between ages 30 and 50; men affected more often than women; non-whites have higher mortality rates
Coronary Artery Disease
101
May manifest as angina pectoris or MI
Coronary Artery Disease
102
Causative factor is atherosclerosis (deposits of cholesterol and lipids within the walls of the artery)
Coronary Artery Disease
103
Management: Screening and Diagnosis
* Electrocardiogram (ECG)
* Echocardiogram
* Electron Beam Computerized Tomography (EBCT)
* Magnetic Resonance Angiography (MRA)
* Stress test
* Angiogram
104
Management: Special procedures
* Angioplasty
* Coronary Artery Bypass Graft
105
Management: Medicines
* Cholesterol-lowering agents
* Anticoagulants, Aspirin, ACE inhibitors, β blockers
* Calcium channel blockers
* Nitroglycerin and nitrates
* Glycoprotein IIb-IIIa inhibitors
* Thrombolytic agents
106
PTCA Stands for
Percutaneous Transluminal Coronary
Angioplasty
107
Referred to as a "balloon treatment”
Percutaneous Transluminal Coronary
Angioplasty
108
Special balloons are used to open up the arteries. involves the use of stents to help keep the arteries open
Percutaneous Transluminal Coronary
Angioplasty
109
CABG Stands for
Coronary Artery Bypass Graft
110
Arteries or veins from elsewhere in the patient's body are grafted from the aorta to the coronary arteries to bypass atherosclerotic narrowing and improve the blood supply to the coronary circulation supplying the myocardium
Coronary Artery Bypass Graft
