Systemic hypertension 1 Flashcards
What does hypertension increase the risk of?
Stroke, decreased cognitive functioning (dementia), death, renal disease, MI, HF
What is the problem with the treatment rationale for HT??
Lack of concordance in taking medication for HT
Asymptomatic disease
Major risk factor for premature death
How can HT lead to HF?
Chronic high blood pressure increases the afterload of the heart, meaning the heart is constantly contracting into a high resistance circulation.
This can result in atrial fibrillation and HF with Preserved ejection fraction (HFPEF)
WHat are the results of an increase in BP of 2mmHg
10% increase risk of mortality due to stroke
7% increase in mortality due to ischeamic hypertension
Increase normal blood pressure maximum increases risk of CV disease!!
Diagnosis – what method can be used so a person with suspected HT can regulate their own BP – what is the clinical threshold normally
AMBULATORY BLOOD PRESSURE MONITORING - BP cuff worn which inflates every 30 mins to measure the pressure.
> or equal to 140/90mmHg
Stage 1 hypertension - clinical and ABPM thresholds
Clinic - 140/90mmHg
ABPM - 135/85mmHg
Stage 2 hypertension - clinical and ABPM thresholds
Clinical - 160/100mmHg
ABPM - 150/95mmHg
Severe hypertension - clinical and ABPM thresholds
180/110 above each of these values = SEVERE HYPERTENSION
What is primary hypertension and what would be the standard treatments?
No obvious cause – seen in 90% of patients
Normally treated by lifestyle modification (change in diet/smoking) or anti hypertensive drug therapy
What is secondary hypertension and what would be the standard treatments?
BP reflective of another problem occuring such as kidney/endocrine disease/steroid secretion
This type more likely in young patients
How can renal artery stenosis cause secondary HT?
Atheromas form due to high BP at renal arteries
This causes the kidneys to perceive a poor perfusion pressure so secretes renin to compensate. This causes increased vascular resistance and increase in BP
PARAMETER FOR INITIATING TREATMENT FOR ISCHAEMIC HT
Individual is under 80 years old, hypertension is measured ( > 140/90mmHg) and they fit one of the following parameters:
- Targeted organ damage
- established CV disease
- diabetic
- renal disease
Having any of these parameters increases risk of CV disease by more than 20%
What are the main therapeutic targets for secondary hypertension ?
Renin-angiotensin-aldesterone system
Sympathetic nervous system
Locally acting vasoconstictors and vasodilators
BP pressure targets for individuals under and over 80 years
Why is this the case?
Less than 80:
clinical - <140/90mmHg
ABPM - <135/85mmHg
Over 80:
clinical - <150/90mmHg
ABPM - <145/85mmHg
Blood vessels lose their compliance and elasticity with age which causes the systolic BP of the heart to peak at a higher value
AT-|| - what are its short term and long term effects and why is it a drug target for HT
Short term -> Na+ and H20 retention, causes an increase in circulating volume and BP
Long term - increased vascular growth, hyperplasia and hypertrophy
Stimulates NA to increase cardiac output but also increases peripheral resistance, which we want to decrease in HT!
