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Case 8 Hypertension > Revision > Flashcards

Revision Flashcards

1
Q

What do you do if the clinical BP is =/>140/90 mmHg? (3)

A

Offer ABPM. HBPM is a suitable alternative.

Calculate CV risk

Look for end organ damage

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2
Q

What do you do if clinical BP is =/>180/110 mmHg? (2)

A

Consider starting anti-hypertensive drug Rx immediately

Consider referral

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3
Q

When do you refer do specialist care?

A

BP >180/110mmHg with signs of papilloedema and/or retinal haemorrhage

OR

Suspected phaeochromocytoma

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4
Q

What is Stage 1 hypertension?

A

Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

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5
Q

What is Stage 2 hypertension?

A

Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg

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6
Q

What is Stage 3 hypertension/Hypertensive Crisis?

A

> 180 mmHg systolic, >110 mmHg diastolic

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7
Q

What lifestyle advice would be offered to those with hypertension?

A
  • Healthy diet and regular exercise
  • Relaxation therapies
  • Reduced alcohol intake
  • Discourage excessive consumption of coffee/other caffeine-rich products
  • Low salt intake
  • Stopping smoking
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8
Q

Who should be offered anti-hypertensives?

A

Those under the age of 80 with stage 1 HTN + target organ damage, established CVD, renal disease, diabetes, CVD risk >20%

Anyone with stage 2 HTN

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9
Q

What is the target clinical BP for treated HTN?

A

140/90 mmHg for those under 80

150/99 mmHg for those over 80

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10
Q

What is 1st line treatment for hypertension for those under 55 years?

A

Angiotensin-converting enzyme (ACE) inhibitor or a low-cost angiotensin-II receptor blocker (ARB).

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11
Q

What is 1st line treatment for hypertension for those over 55 year and/or afro-Caribbean people?

A

Calcium-channel blockers. Thiazide-like diuretic if CCB is unsuitable.

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12
Q

What is the 2nd step of treatment?

A

CCB + ACE-I or ARB

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13
Q

What is the 3rd step of treatment?

A

CCB + ACE-I/ARB + Diuretic (thiazide-like)

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14
Q

Which medication is first line for HTN in diabetic patients

A

ACE-I

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15
Q

What is HTN a risk factor for? (4)

A

Stroke, IHD, HF, CKD

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16
Q

When measuring BP in the clinic multiple times, which reading should you record?

A

The lowest

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17
Q

What types of end organ damage can occur (3)?

A

Left ventricular hypertrophy, CKD, hypertensive retinopathy

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18
Q

What tool is used to calculate CVD risk?

A

QRISK2

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19
Q

How is end organ damage investigated for? (4)

A

Bloods, urine, ECG, CXR

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20
Q

What is the definition of hypertensive urgency?

A

elevated BP (>180/110) but no target organ damage.

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21
Q

What is the definition of hypertensive emergency?

A

Elevated BP with end organ damage.

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22
Q

What complication can occur in hypertensive emergency?

A

Encephalopathy

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23
Q

How is a hypertensive emergency managed?

A

IV nitroglycine (vasodilator)/CCB/beta-blocker, ICU admission

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24
Q

What are the symptoms of hypertensive urgency? (4)

A

o Headache
o SoB
o Nosebleeds
o Severe anxiety

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25
Q

What are the symptoms of a hypertensive emergency? (6)

A 
o	Chest pain
o	SoB
o	Back pain
o	Numbness/weakness
o	Vision change
o	Difficulty speaking
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26
Q

How is BP calculated?

A

Cardiac Output x Total Peripheral Resistance

27
Q

What modifies BP in short term?

A

baroreceptors, chemoreceptors, ANS

28
Q

What modifies BP after 4-6 hours?

A

RAAS

29
Q

How is arterial pressure raised by CNS? (4)

A

1) The SNS releases noradrenaline from nerve terminals
2) NA acts on alpha-adrenergic receptors of vascular smooth muscle cell (VSMC)
3) arterioles constricted
4) Heart directly stimulated

30
Q

What does activation of beta-adrenoreceptors cause? (2)

A

Reduced contractility of blood vessels and increased contractility of the heart

31
Q

When is adrenaline clinically used? (3)

A

Anaphylactic shock, cardiogenic shock, cardiac arrest

32
Q

When is NA used? (2)

A

severe hypotension, septic shock

33
Q

When are dopamine and dobutamine clinically used? (2)

A

Heart failure and cardiogenic shock

34
Q

Which nerve innervates the carotid body?

A

Hering’s nerve, which is branch of the glossopharyngeal

35
Q

Which nerves innervates the aortic arch baroreceptors?

A

Vagus

36
Q

What happens when you stand up?

A

strong sympathetic discharge from baroreceptors

37
Q

What to the chemoreceptors detect?

A

low O2, high Co2 and acidosis

38
Q

What is the atrial volume reflex?

A

Increased Atrial stretch due to increase pressure causes reduced water reabsorption & Increased filtration of fluid into renal tubule. This fluid loss via kidneys decreasing BP.

39
Q

What does the macula densa detect?

A

Rise in Na+ concentration (low arterial pressure)

40
Q

What does the macula densa do when it detects an increased Na+ concentration?

A

Causes release of renin which causes efferent arteriole resistance

41
Q

What produces angiotensinogen?

A

the liver

42
Q

What does aldosterone cause?

A

increased Na+ absorption and secretion of K+ and H+

43
Q

What does angiotensin II cause? (5)

A

Increased sympathetic activity, increased Na+Cl- + H20 reabsorption, aldosterone release, arteriole vasoconstriction , ADH release

44
Q

What happens to arteries in HTH and T2DM?

A

Increase in wall thickness, impairment of endothelial function

45
Q

How does obesity cause hypertension?

A

Reduction in adiponectin (vasodilator) cause increased contractility of small arteries and increased vascular tone

46
Q

What is the main side-effect of ACE-I?

A

Tickly cough

47
Q

Which anti-hypertensives can be used safely during pregnancy?

A

Nifedipine, labetolol, methyldopa

48
Q

What is a main side-effect of Calcium channel blockers?

A

Ankle swelling

49
Q

What is a main side effect of loop diuretics?

A

Gout attack

50
Q

What is a main side effect of thiazide diuretics?

A

Hyponatriemia

51
Q

What is a main side effect of aldosterone antagonists?

A

Hyperkalaemia

52
Q

How does renal disease cause secondary HTN?

A

Kidneys don’t function optimally which causes increased fluid retention

53
Q

How does glomerular disease cause secondary HTN?

A

glomerulus doesn’t filter waste and sodium which increases plasma volume

54
Q

How does renovascular disease lead to secondary HTN?

A

lack of perfusion to kidney which causes increased fluid retention

55
Q

How does pheochromacytoma cause secondary HTN?

A

It’s a tumour which occurs in the adrenal gland and causes increased release of adrenaline and Noradrenaline which increases BP

56
Q

How does Sleep Apnea lead to secondary HTN?

A

lack of oxygen causes increased heart contractility at night

57
Q

How do brain tumours and enchepalitis lead to secondary HTN?

A

There is decreased blood flow in the brain and the body attempts to counteract this by increasing BP

58
Q

What 4 features are suggestive of secondary HTN?

A

resistant HTN, a sudden acute rise from a previous stable value, proven age of onset before puberty, under 30 with no FH

59
Q

What medications can cause secondary HTN?

A

NSAIDs, stimulants, OCP, antidepressants, calcineurin inhibitors (tacrolimus)

60
Q

What causes a string-of-beads appearance on CT angiogram?

A

medial fibromuscular dysplasia

61
Q

What is the target average ABPM/HBPM?

A

<135/85 if under 80 y/o

<145/85 if >80 y/o

62
Q

What medication is preferred in hypertensive emergency in patients with coronary ischaemia and CCF?

A

IV nitroglycine

63
Q

What are the complications of giving ACE-i in someone with renal artery stenosis?

A

Flash pulmonary oedema

Case 8 Hypertension (1 decks)

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