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CP > L: Hypertension > Flashcards

L: Hypertension Flashcards

1
Q

High blood pressure

A

Hypertension

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2
Q

It is not a disease but an important risk factor for cardiovascular complications

A

Hypertension

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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

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4
Q

Blood Pressure Categories:
Normal

A

< 120mmHg Systolic and < 80mmHg Diastolic

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5
Q

Blood Pressure Categories:
Elevated

A

120-129mmHg Systolic and < 80mmHg Diastolic

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6
Q

Blood Pressure Categories:
HBP/HTN Stage 1

A

130-139mmHg Systolic or 80-89mmHg Diastolic

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7
Q

Blood Pressure Categories:
HBP/HTN Stage 2

A

140mmHg Systolic or higher or 90mmgHg Diastolic or higher

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8
Q

Blood Pressure Categories:
HTNS Crisis

A

Higher than 180 and/or Higher than 120

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9
Q

What are the Categories of Blood Pressure

A

Normal
Elevated
HBP/HTN Stage 1
HBP/HTN Stage 2
HTNS Crisis

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10
Q

Hypertension Complications

A
  • Myocardial infarction
  • Stroke
  • Hypertensive encephalopathy / malignant hypertension
  • Dissecting aortic aneurysm
  • Hypertensive nephrosclerosis
  • Peripheral vascular disease
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11
Q

Causes of Hypertension
Primary hypertension

A
  • 90-95%
  • Essential hypertension
  • Etiology is unknown
  • Genetic factors clearly play a part
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12
Q

Causes of Hypertension
Secondary hypertension

A
  • 5-10%
  • Renal disease
  • Endocrine disease
  • Vascular causes
  • Drugs (sympathomimetic amines, estrogens, cyclosporine, erythropoietin, NSAIDS, steroids)
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13
Q

Categories of Causes in Hypertension

A

Primary hypertension
Secondary hypertension

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14
Q

Formula for Blood Pressure

A

BP = CO ✕ TPR

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15
Q

CO stands for

A

Cardiac Output

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16
Q

TPR stands for

A

Total Peripheral Resistance

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17
Q

In hypertensive individuals, cardiac output is ____

A

not increased

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18
Q

In hypertensive individuals, high blood pressure arises as a result of _____ caused by constriction of small arterioles

A

increased total peripheral resistance

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19
Q

In hypertensive individuals, high blood pressure arises as a result of increased total peripheral resistance caused by ____

A

constriction of small arterioles

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20
Q

The mean blood pressure is the product of

A

cardiac output and total peripheral resistance

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21
Q

Blood pressure is measured using a

A

Sphygmomanometer

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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

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23
Q

Blood Pressure is measured by

A

Sphygmomanometer
Manual (Mercury & Aneroid)
Digital

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24
Q

Hypertension itself causes ___

A

no symptoms

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25
Q

What is a present symptom in HTN

A

Headache

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26
Q

It is usually unclear if this is caused by hypertension or is an incidental finding

A

Headache

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27
Q

Hypertension may also come to light for first time when the individual suffers a

A

hypertension-related complication

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28
Q

hypertension-related complication example

A

myocardial infarction or stroke.

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29
Q

Contributing factors in HTN

A
  • Obesity
  • Excess alcohol
  • Salt intake
  • Lack of exercise
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30
Q

Other risks in HTN

A
  • Smoking
  • Diabetes
  • Hyperlipidemia
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31
Q

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

A

Hypertensive urgency

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32
Q

Hypertensive emergency is also known as

A

Malignant hypertension or accelerated

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33
Q

A high blood pressure with potentially life-threatening symptoms and signs indicative of acute impairment of one or more organ systems

A

Hypertensive emergency

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34
Q

Hypertensive emergency is evident in the ___, where papilloedema, hemorrhages and/or exudates may be present

A

optic fundus

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35
Q

Medical emergency that requires hospital admission and rapid control of BP over ___ towards normal levels

A

12-24 hours

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36
Q

Fatal in the absence of treatment, with a __ survival of less than 20%

A

1-year

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37
Q

Fatal in the absence of treatment, with a 1-year survival of __

A

less than 20%

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38
Q

Diagnosis: Home or ambulatory blood pressure measurements is recommended to prevent

A

“white coat hypertension”

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39
Q

Non-Pharmacologic Approaches: Weight loss results in reduction in BP of about __ (for overweight patients)

A

2.5/1.5 mmHg per kg

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40
Q

Non-Pharmacologic Approaches: Diet high in fruit and vegetables, legumes and whole grain cereal improves

A

Cardiovascular risk

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41
Q

Non-Pharmacologic Approaches: Reduce salt intake (aim is __ daily sodium intake)

A

<100 mmol

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42
Q

Non-Pharmacologic Approaches: Regular dynamic exercise for at least __ on most days

A

30 minutes

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43
Q

AB/CD Algorithm by

A

Williams et al 2004

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44
Q

Initial choice of ACE inhibitor or angiotensin
receptor blocker and β blocker as first line
therapy in younger nonblack patients (<55
years)

A

Treatment A/B

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45
Q

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

A

Treatment A/B

46
Q

In treatment A/B the initial choice as first line therapy are

A

ACE inhibitor or angiotensin
receptor blocker and β blocker

47
Q

Treatment A/B is suitable for

A

younger nonblack patients (<55
years)

48
Q

For elderly and black patients, who tend to have hypertension associated with low renin concentration, calcium channel blockers and thiazide diuretics are recommended

A

Treatment C/D

49
Q

What is the recommended medicine in the treatment C/D

A

calcium channel blockers and thiazide diuretics

50
Q

Treatment C/D is suitable for

A

elderly and black patients

51
Q

What happens if initial drug therapy fails

A

A or B is combined with C or D

52
Q

Diuretics:

A
  • Thiazide: Bendroflumethiazide Hydrochlorothiazide
  • Loops: Furosemide
  • K-Sparing: Spironolactone
53
Q

Diuretics
Thiazide:

A

Bendroflumethiazide Hydrochlorothiazide

54
Q

Diuretics
Loops:

A

Furosemide

55
Q

Diuretics
K-Sparing:

A

Spironolactone

56
Q

Major ADRs in Diuretics

A
  • Hyperlipidemia
  • Impotence
  • Uremia
  • Dehydration
  • Hyperkalemia
  • Gynecomastia
57
Q

Major ADRs in Calcium Channel Blockers (Dihydropyridine)

A
  • Flushing
  • Edema
  • Postural hypotension
  • Headache
58
Q

Calcium Channel Blockers (Dihydropyridine)

A
  • Nifedipine
  • Amlodipine
59
Q

Notes: Concerns about long term metabolic effects

60
Q

Notes: Cheap, effective. Efficacy proven in clinical trials.

61
Q

Notes: More appropriate in older patients

62
Q

Notes: for patients with cardiac failure

63
Q

Notes: for resistant hypertension.

64
Q

Notes: Not well tolerated (especially early in treatment)

A

Calcium Channel Blockers (Dihydropyridine)

65
Q

Notes: Recent trials confirm reductions in stroke and myocardial infarction

A

Calcium Channel Blockers (Dihydropyridine)

66
Q

Notes: Similar efficacy to thiazides

A

Calcium Channel Blockers (Dihydropyridine)

67
Q

Notes: for elderly patients and those with ischemic heart disease or diabetes

A

Calcium Channel Blockers (Dihydropyridine)

68
Q

Angiotensin Converting Enzyme (ACE) Inhibitor

A
  • Captopril
  • Enalapril
  • Lisinopril
  • Perindopril
  • Ramipril
69
Q

Major ADRs in Angiotensin Converting Enzyme (ACE) Inhibitor

A
  • Cough
  • Rash, taste disturbance
  • Renal failure
  • Angio-edema
70
Q

Notes: More expensive

A

Angiotensin Converting Enzyme (ACE) Inhibitor

71
Q

Notes: Cough very common

A

Angiotensin Converting Enzyme (ACE) Inhibitor

72
Q

Notes: Appropriate for use in younger patients and those with cardiac failure or diabetes

A

Angiotensin Converting Enzyme (ACE) Inhibitor

73
Q

ɑ-BLOCKERS

A
  • Prazosin
  • Doxazosin
  • Terazosin
74
Q

Major ADRs in ɑ-BLOCKERS

A
  • Edema
  • Postural hypotension
75
Q

Notes: More expensive

A

ɑ-BLOCKERS

76
Q

Notes: Adverse effects common

A

ɑ-BLOCKERS

77
Q

Notes: No evidence to date of long term efficacy

A

ɑ-BLOCKERS

78
Q

Notes: Less effective than thiazides at preventing heart failure and combined cardiovascular outcomes (ALLHAT study)

A

ɑ-BLOCKERS

79
Q

Notes: Second-line

A

ɑ-BLOCKERS

80
Q

Angiotensin Receptor Blockers (ARBS)

A
  • Losartan
  • Valsartan
  • Irbesartan
81
Q

Major ADRs in Angiotensin Receptor Blockers (ARBS)

A
  • Renal failure
  • Edema
  • Headache
82
Q

Notes: More expensive

A

Angiotensin Receptor Blockers (ARBS)

83
Q

Notes: for patients in whom ACE inhibitor indicated but not tolerated due to cough

A

Angiotensin Receptor Blockers (ARBS)

84
Q

Notes: More effective in preventing vascular events than atenolol in patients with left ventricular hypertrophy (LVH)

A

Angiotensin Receptor Blockers (ARBS)

85
Q

Centrally Acting Vasodilators

A
  • Methyldopa
  • Moxonidine
86
Q

Major ADRs in Centrally Acting Vasodilators

A
  • Tiredness
  • Depression
87
Q

Notes: Poorly tolerated

A

Centrally Acting Vasodilators

88
Q

Notes: Only use in severe hypertension or hypertension of pregnancy

A

Centrally Acting Vasodilators

89
Q

Notes: Third line

A

Centrally Acting Vasodilators

90
Q

Direct-Acting Vasodilators

A
  • Diazoxide
  • Minoxidil
  • Nitroprusside
91
Q

Major ADRs in Direct-Acting Vasodilators

A
  • Edema
  • Postural hypotension
  • Headache
92
Q

Notes: Poorly tolerated

A

Direct-Acting Vasodilators

93
Q

Notes: Only use in severe hypertension

A

Direct-Acting Vasodilators

94
Q

CAD Stands for

A

Coronary Artery Disease

95
Q

CHD Stands for

A

Coronary Heart Disease

96
Q

IHD Stands for

A

Ischemic Heart Disease

97
Q

ASHD Stands for

A

Atherosclerotic Heart Disease

98
Q

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

A

Coronary Artery Disease

99
Q

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

A

Coronary Artery Disease

100
Q

Occurs most often between ages 30 and 50; men affected more often than women; non-whites have higher mortality rates

A

Coronary Artery Disease

101
Q

May manifest as angina pectoris or MI

A

Coronary Artery Disease

102
Q

Causative factor is atherosclerosis (deposits of cholesterol and lipids within the walls of the artery)

A

Coronary Artery Disease

103
Q

Management: Screening and Diagnosis

A
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Electron Beam Computerized Tomography (EBCT)
  • Magnetic Resonance Angiography (MRA)
  • Stress test
  • Angiogram
104
Q

Management: Special procedures

A
  • Angioplasty
  • Coronary Artery Bypass Graft
105
Q

Management: Medicines

A
  • Cholesterol-lowering agents
  • Anticoagulants, Aspirin, ACE inhibitors, β blockers
  • Calcium channel blockers
  • Nitroglycerin and nitrates
  • Glycoprotein IIb-IIIa inhibitors
  • Thrombolytic agents
106
Q

PTCA Stands for

A

Percutaneous Transluminal Coronary
Angioplasty

107
Q

Referred to as a “balloon treatment”

A

Percutaneous Transluminal Coronary
Angioplasty

108
Q

Special balloons are used to open up the arteries. involves the use of stents to help keep the arteries open

A

Percutaneous Transluminal Coronary
Angioplasty

109
Q

CABG Stands for

A

Coronary Artery Bypass Graft

110
Q

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

A

Coronary Artery Bypass Graft

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