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Personalised Medicine - Cardiovascular > L9 - Hypertension I > Flashcards

L9 - Hypertension I Flashcards

1
Q

Why is hypertension normally asymptomatic?

A

Most people don’t know they have hypertension
- Unless extremely high blood pressure
Hypertension normally declares itself when an event occurs e.g. stroke, chronic renal disease, heart failure

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2
Q

What are the 7 major diseases hypertension is a risk factor for?

A 
Stroke 
Myocardial infarction 
Heart failure 
Chronic renal disease
Cognitive renal disease
Cognitive decline 
Atrial fibrillation
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3
Q

What is a stroke?

A

Ischaemic – cutting off blood supply to part of brain
- Atheroma in coronary arteries
- Super added thrombus
- Embolus – blood clot block blood supply to brain
Haemorrhage – bleed into the brain tissue

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4
Q

What is myocardial infarction?

A

Ischaemia and infarction into the heart caused by an atheroma
Acute blockage of coronary heart –> heart attack –> myocardial infarction

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5
Q

What is heart failure?

A

If you have had a heart attack and damage heart –> pump your heart into a high-pressure state –> heart fails more
- Blood pressure = after load
Even if you haven’t had heart failure - changes in heart develop overtime which means the heart becomes inefficient

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6
Q

What is chronic renal disease?

A

Renal vasculature is susceptible to a sustained rise in blood pressure
Start to lose nephrons in kidney
Hard to know which comes first between hypertension and chronic renal disease

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7
Q

What is cognitive decline?

A

Hypertension effect small vessels in the

Slowly lose bits of brain tissue overtime – e.g. leads to dementia

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8
Q

What is atrial fibrillation?

A

Hypertension increases the risk of atrial fibrillation –> increases independent stroke risk

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9
Q

Why is it so important to find hypertension treatments?

A

Important preventable cause of premature morbidity and mortality
- Morbidity – all the factors that cause symptoms, side effects, inconvenience
Huge opportunity for pharmaceutical companies – commonly used so get a good return

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10
Q

Using population data - each 2 mmHg rise in systolic BP is associated with?

A

7% increased mortality from ischaemic heart disease

10% increased mortality from stroke

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11
Q

Why is hypertension considered arbitary?

A

Isn’t a level where we get hypertension
Just a point where blood pressure causes more issues
Set a range which is considered ‘safe’
- Even within this range there is still a continuum in risk level

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12
Q

What is the clinical BP where you are diagnosed with suspected hypertension?

A

Clinic BP 140/90 mmHg or higher

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13
Q

What are people with suspected hypertension offered to confirm a diagnosis?

A

Ambulatory BP monitoring (ABPM)

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14
Q

What is ambulatory BP monitoring?

A

During the day – record every 30min
During the night – record every hour
ABPM results should be slightly lower then clinical results
Don’t need to have both results high to get a diagnosis

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15
Q

Stage 1 hypertension - clinic BP and ABPM values

A

Clinic - 140/90

ABPM - 135/85

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16
Q

Stage 2 hypertension - clinic BP and ABPM values

A

Clinic - 160/100

ABPM - 150/95

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17
Q

Severe hypertension - clinic BP and ABPM values

A

Clinic SBP - 180

Clinical DBP 110

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18
Q

What % of patients have primary hypertension?

A

85-90% of people have this type

No underlying cause – may be genetic

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19
Q

What is the treatment for primary hypertension?

A 
Lifestyle modification – limit 
- Obesity/lack of exercise
- Salt 
- Smoking 
- Alcohol 
Antihypertensive drug therapy
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20
Q

What is the cause of secondary hypertension?

A

Symptoms/signs of an underlying cause

  • Renal disease
  • Endocrine disease - tumours which release steroids or catecholamine
21
Q

What are the characteristics of secondary hypertension?

A

More common in young patients
Resistant BP - does not lower when on 1 or more therapies
- Can often be because patients aren’t taking their tablets

22
Q

When do you offer antihypertensive drug treatment to people aged under 80 with stage 1 hypertension?

A

When they have one or more of

  • Target organ dama
  • Established cardiovascular disease - heart attack or stroke
  • Renal disease
  • Diabetes
  • A 10 year cardiovascular risk of 20% or greater - algorithms
23
Q

What evidence is there that hypertension is damaging organs?

A

Eye - can see changes in arteries
Heart – left ventricular hypertrophy
Kidney – protein in urine, damaged renal function

24
Q

When do you offer antihypertensive drug treatment to people of any age with stage 2 hypertension?

A

Right away

Risk is high enough to warrant it

25
Q

Why are BP targets different in old people?

A

Some changes in vasculature/BP are just to do with ageing
Lowering BP too much in old people can be bad
- Can become dizzy – more prone to injuries if they fall

26
Q

Under 80 years old BP target

A

< 140/90

27
Q

Over 80 years old BP target

A

< 150/90

28
Q

What two factors is blood pressure dependent on?

A

Cardiac output and peripheral resistance

In hypertension – raised peripheral resistance is key

29
Q

What two systems is peripheral resistance dependent on?

A

Sympathetic nervous system (noradrenaline)
Angiotensin-Aldosterone system
Peripheral resistance is affected by local vascular vasoconstrictors
and vasodilator mediators

30
Q

Angiotensin II overall role

A 
Bad guy in renin-angiotensin-aldosterone system  
Vasoconstrictor 
Enhances noradrenaline release 
Has vascular effects 
- Hypertrophy 
- Aldosterone release - Na reabsorption
31
Q

Noradrenaline overall role

A

Bad guy in sympathetic nervous system
Vasoconstrictor and increases cardiac output
Causes renin release – converts angiotensinogen to angiotensin I
Hypertrophy of vasculature
Aldosterone release – Na retention

32
Q

What do ACE inhibitors do?

A

Decrease afterload on heart and lower the BP

33
Q

What are 3 examples of ACE inhibitors?

A

Ramipril
Enalapril
Perindopril

34
Q

What are the clinical indications of ACE inhibitors?

A

Hypertension
Heart failure
Diabetic nephropathy

35
Q

What are the side effects of ACE inhibitors?

A

Can get cough – then might swap to angiotensin II receptor blockers

36
Q

What are the issues with ACE inhibitors?

A

Substrate for that enzyme builds up and competes with the drug for the enzyme
- Substrate builds up and drugs becomes less effective
- Substrate overcomes the competition - still some angiotensin II still produced
Receptor blockers then block it directly at the receptor

37
Q

What are 3 examples of Angiotensin II receptor blockers?

A

Losartan
Valsartan
Candesartan

38
Q

What are the clinical indications of Angiotensin II receptor blockers?

A

Hypertension
Diabetic nephropathy
Heart failure (when ACE-I contraindicated)

39
Q

What are the side effects of Angiotensin II receptor blockers?

A 
Symptomatic hypotension
Hyperkalaemia
Potential for renal dysfunction
Rash
Angio-oedema (swelling of tissue) 
Contraindicated in pregnancy
Generally well tolerated
40
Q

Why do angiotensin II receptor blockers cause symptomatic hypotension?

A

Especially in volume deplete patients
System tries to maintain BP – many mediated by angiotensin II
If you use ARB you are blocking the thing mediating their circulation
Get lightheaded and faint

41
Q

Why do angiotensin II receptor blockers cause hyperkalaemia?

A

Aldosterone encourages K secretion

Blocking this system enhances K retention

42
Q

Why are angiotensin II receptor blockers contradicted in early pregnancy?

A

Angiotensin II has key effects in early foetal development

43
Q

Beta blockers overview

A

Only used in certain circumstances
Block noradrenaline and renin
Impact cardiac output

44
Q

Ca channel blockers overview

A

Impact peripheral resistance

45
Q

Aldosterone antagonists overview

A

Block the effect of aldosterone

Other diuretics such as thiazides

46
Q

Alpha blockers overview

A

Old drugs – still used in resistance cases
Block pathway from brain through to sympathetic nervous system
Impact peripheral resistance

47
Q

Renin inhibitors overview

A

Blocks production of angiotensin I

48
Q

Why is some angiotensin II still produced with angiotensin II receptor blockers?

A

ARB blocks at the receptor level

  • Angiotensin II competes with the drug for the receptor
  • ACE pathway is not the only way angiotensin II can be produced

Personalised Medicine - Cardiovascular (11 decks)

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