Management of Hypertension Flashcards
What is blood pressure?
The pressure exerted on arterial walls by the volume of blood ejected from the heart.
What is systolic pressure?
The peak pressure in the arteries during heart contraction (the higher value in a blood pressure reading).
What is diastolic pressure?
The minimum pressure in the arteries when the heart is relaxed (the lower value in a blood pressure reading).
How is blood pressure calculated?
BP = Cardiac Output (CO) × Systemic Vascular Resistance (SVR).
How is blood pressure related to blood flow and resistance?
Blood pressure is the product of blood flow and the resistance by the vessels.
How do drugs typically reduce blood pressure?
By either reducing cardiac output or decreasing resistance in the blood vessels.
What is hypertension?
Hypertension is when the force of the blood pushing against the walls of the arteries is consistently too high.
What damage can hypertension cause?
It can damage artery walls, cause fatty deposits, and limit circulation of blood and oxygen.
What is secondary hypertension?
High blood pressure caused by identifiable factors like hormone abnormalities, kidney disease, diabetes, or certain medications.
What are common risk factors for hypertension?
Drinking too much alcohol, smoking, being overweight, lack of exercise, and too much salt in the diet.
What is primary hypertension?
Also known as essential hypertension, it accounts for 95% of cases and has no identifiable cause.
What are the most dangerous effects of hypertension?
Heart attack, heart failure, stroke, kidney damage, and plaque buildup in arteries.
Why is it important to treat hypertension?
It is a major risk factor for premature morbidity and mortality, linked to stroke, heart attack, heart failure, and kidney disease.
What are the stages of hypertension?
Stage 1: Clinic reading 140/90–159/99, home reading 135/85–149/94.
Stage 2: Clinic ≥160/100, home ≥150/95.
Stage 3: Clinic systolic ≥180, diastolic ≥110.
When should ambulatory blood pressure monitoring (ABPM) be used?
In cases of suspected “white coat” hypertension, borderline cases, or treatment-resistant hypertension.
What are the usual asymptomatic symptoms of hypertension?
Usually asymptomatic.
What examinations do you do when testing for hypertension?
Urinalysis – dipstick / albumin:creatine ratio (blood and protein)
12 lead ECG if indicated (left ventricular hypotrophy)
U + E (kidney function, sodium and potassium)
Lipid profile
BM / Hb1AC (ruling out diabetes)
OP ECHO if indicated (function of heart)
Fundoscopy (eyes)
Check hx for neurological symptoms
Check signs of heart failure / heart sounds
Who needs treatment for stage 1 hypertension?
Target organ damage
Established / history cardiovascular disease
Renal disease
Diabetes
An estimated 10-year risk of cardiovascular disease of 10% or more
Who needs treatment stage 2 hypertension?
Everyone
What lifestyle changes can help manage hypertension?
Weight management, reducing alcohol consumption to ≤14 units/week, reducing salt intake to 4.4g/day, and regular exercise.
What are the main classes of medications used to treat hypertension?
ACE inhibitors or ARBs
Calcium channel blockers
Thiazide-type diuretics
What happens if someone is resistant to the first line of treatment?
B-blocker (second line)
Other alpha blockers, spironolactone
How do ACE inhibitors work?
They block the conversion of angiotensin I to angiotensin II, reducing blood pressure by dilating blood vessels and decreasing fluid retention.
What does angiotensin II do?
Causes vessels to block - increasing blood pressure
What do ACE inhibitors effect?
Heart rate and cardiac output
What do ACE inhibitors reduce the release of?
Aldosterone which causes fluid and water retention
What are examples of ACE inhibitors?
Ramipril, enalapril, lisinopril, perindopril
What are common side effects of ACE inhibitors?
Dizziness, orthostatic hypotension, gastrointestinal stress, cough, and acute kidney disease.
Which ethnicity can you not use ACE inhibitors on?
Black and Afro-Caribbean
Who do you not give ACE inhibitors to?
Bilateral or renal artery stenosis
Hyperkaliemia
Hypotension
What is a rare side effect of ACE inhibitors?
Angioedema
When are angiotensin II receptor antagonists (AIIRA) or angiotensin II blockers (ARB) given?
When ACE inhibitors don’t work.
What is the role of angiotensin II receptor antagonists (AIIRA) or angiotensin II blockers (ARB)?
Reduced the action of angiotensin II.
What are the properties of angiotensin II receptor antagonists (AIIRA) or angiotensin II blockers (ARB) similar to?
ACE inhibitors
What are dihydropyridines?
Nifedipine, amlopidine, felodipine – predominately affecting vascular smooth muscle – causing vasodilation – side effect: swelling of ankles
What are calcium channel blockers, and how do they work?
They block calcium from entering cells, causing vasodilation, reduced heart rate, and lower blood pressure.
What happens to the tube during vasodilation?
Tubes get wider to reduce pressure
What are examples of Angiotensin II receptor antagonists (AIIRA) or angiotensin II blockers (ARB)
Candesartan, irbesartan, losartan
What are the side effects of calcium channel blockers?
Ankle swelling, flushing, headaches, dizziness, constipation, and bradycardia.
What are the two types of calcium channel blockers?
Dihydropryidines
Non-dihydropryidines
What are non-dihydropyridines?
Verapamil & diltiazem – slows the heart rate affecting myocardial tissue
How do thiazide-type diuretics work in hypertension?
They reduce blood pressure by decreasing sodium and water retention, lowering blood volume and peripheral resistance.
What are common side effects of thiazide diuretics?
Dizziness, electrolyte imbalances, and gastrointestinal disturbances.
What are rare side effects of thiazide type diuretics?
Blood disorders – bone marrow suppression
Impotence
What are beta blockers, and when are they used in hypertension?
Beta blockers reduce blood pressure by blocking beta receptors, used as a second-line drug or in specific cases like pregnancy or sympathetic overactivity.
