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SAM > Systemic Hypertension > Flashcards

Systemic Hypertension Flashcards

1
Q

Systemic Blood Pressure =

A

CO X SVR

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2
Q

Name two ways by which systemic blood pressure is regulated

A

Sympathetic Nervous System
Renin-Angiotensin-Aldosterone-System (RAAS)

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3
Q

Describe RAAS

A
  • Initiated by hypotension
  • Kidneys detect low GFR and release Renin
  • Renin converts Angiotensinogen (released by liver) into Angiotensin I
  • Angiotensin I converted to Angiotensin II by Angiotensin Converting Enzyme (ACE - produced by lungs)
  • Angiotensin II causes vasoconstriction of all blood vessels
  • Angiotensin II acts on adrenal gland to release Aldosterone
  • Aldosterone stimulates reabsorption of sodium and water
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4
Q

Systolic BP >_______mmHg and diastolic >________mmHg is considered hypertension

A

160;120

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5
Q

T/F: Similar to humans, almost 80% of hypertension cases in cats and dogs are idiopathic.

A

False - Hypertension in dogs and cats is secondary in >80% of cases

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6
Q

By what two methods can we measure BP?

A

Indirect
Direct

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7
Q

Arterial catheterization is an example of __________ BP measurement and is the GOLD STANDARD.

A

Direct

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8
Q

Doppler and oscillometric measurement are considered indirect measurements of BP. When is one preferred over the other?

A

Doppler - good for cats and small dogs
Oscillometric - good for medium to large breed dogs

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9
Q

BP cuffs should be ________ the circumference of the chose site.

A

30-40%

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10
Q

Explain what might happen if an incorrect cuff size is chosen for a patient

A

If too big = falsely low BP
If too small = falsely high BP

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11
Q

Why is it preferred for patients to be in ventral or lateral recumbency when measuring BP?

A

Limit the vertical distance from the base of the heart to the cuff

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12
Q

Identify the mistake. You have a patient come in that you suspect is hypertensive. You rush the patient to the back and get a BP reading using an indirect method. Based on this reading, you diagnose the patient with systemic hypertension and send it home with appropriate medications.

A

BP measurement should be done in quiet, calm areas with the owner present. You should allow the patient to acclimate to the BP equipment prior to measuring. You’re supposed to throw out the first result and then average the next 5-7 readings.

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13
Q

Identify the four possible areas of TOD (Target Organ Damage)

A
  1. Eyes
  2. Kidney
  3. Brain
  4. Heart and vasculature
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14
Q

SBP >180mmHg is considered __________ hypertensive with a ________ TOD risk

A

Severely; high

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15
Q

SBP <140mmHg is considered __________ with a ________ TOD risk

A

Normotensive; minimal

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16
Q

SBP 160-179mmHg is considered ________ with a ________ TOD risk

A

Hypertensive; moderate

17
Q

SBP 140-159mmHg is considered __________ with a ________ TOD risk

A

Prehypertensive; low

18
Q

Ddx for secondary hypertension in cats

A
  • CKD
  • Hyperthyroidism
  • Adrenal Disorders (Pheochromocytoma, Hyperaldosteronism, HAC)
  • Medications
19
Q

Ddx for systemic hypertension in dogs

A
  • Kidney disease (acute and chronic)
  • HAC
  • DM
  • Pheochromocytoma
  • Hyperaldosteronism (uncommon)
20
Q

Name some general guidelines for when hypertension should be treated

A
  • Severe hypertension (>180mmHg)
  • Evidence of TOD w moderate to severe hypertension
  • Persistent BP >160mmHg w disease associated with hypertension
21
Q

A patient’s BP measures 165mmHg, but it has no evidence of TOD. What is the best recommendation at this time?

A

Recheck BP in 1-2 weeks

22
Q

Amlodipine is a ___________ channel blocker and is the first line of treatment in hypertensive _________

A

Calcium; cats

23
Q

A cat comes to you with BP >180mmHg and signs of CKD. In addition to addressing the CKD, you want to start the cat on amlodipine. When would you ask the client to bring their cat back for a recheck?

A

7-10d is when you will start to see the max effect
If patient is still hypertensive or hypotensive, the dose can be altered

24
Q

Name some ACE inhibitors

A

Benazepril
Enalapril

25
Q

Discuss the mechanism of action of ACE inhibitors

A
  • ACE (Angiotensin Converting Enzyme) converts Angiotensin I to II; Inhibiting ACE prevents this conversion and promotes vasodilation
  • Preferentially vasodilators efferent arteriole (the vessel leaving the glomerulus)
26
Q

What is the first line of treatment in dogs with hypertension? What drug can be added in if the patient is severely hypertensive?

A

ACE inhibitors +/- amlodipine

27
Q

Why might we see azotemia develop in patients that are on ACE inhibitors?

A

Decreased GFR d/t preferential dilation of the efferent arteriole

28
Q

Telmisartan is a _________________blocker

A

Angiotensin II Receptor

29
Q

When might telmisartan be used?

A

Moderate hypertension in cats

30
Q

It is important to check ______ and ________ values 7-10d after starting a patient on BP medications

A

Renal; electrolyte

31
Q

Hydrazaline and sodium nitroprusside are _________

A

Direct arterial vasodilators (emergency drugs)

32
Q

What two drugs can be used for pheochromocytomas?

A

Alpha Adrenergic Antagonists - inhibit catecholamine production

Prazosin
Phenoxybenzamine

33
Q

Spironolactone is an __________ and can be useful with hyperaldosteronism

A

Aldosterone antagonist - reduces sodium and water reabsorption

34
Q

After starting treatment for hypertension, the goal should be to reach systolic BP between ___________

A

110 and 140mmHg, minimum of <160mmHg

35
Q

A cat with retinal hemorrhage is diagnosed with systemic hypertension secondary to CKD. Treatment was initiated. When should the patient come back?

A

3d b/c TOD present

36
Q

In general, a patient being treated for hypertension should be rechecked every _________ once BP has stabilized.

A

3 months

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