Week 2 - Hypertension

Question 1

What is hypertension?

Answer 1

high blood pressure

Question 2

What is hypertension an important risk factor for?

Answer 2

stroke, MI, heart failure

Question 3

What is the cause of hypertension?

Answer 3

90% idiopathic. 10% secondary to another illness

Question 4

What illnesses are hypertension commonly secondary to?

Answer 4

• chronic renal disease,
• renal artery stenosis
• endocrine diseases (cushings or conns)

Question 5

What is stage 1, 2 and 3 hypertension?

Answer 5

stage 1 - 140/90 or higher
stage 2 - 160/100 or higher
stage 3 - 180/120 or higher

Question 6

What are risk factors for hypertension?

Answer 6

• smoking,
• diabetes,
• renal disease,
• hyperlipidaemia,
• left ventricle hypertrophy

Question 7

How are kidneys involved in blood pressure?

Answer 7

release renin upon low BP, which then release angiotensin and aldosterone - vasoconstrictor and salt/water retention

Question 8

What is the aetiology of hypertension?

Answer 8

polygenic - major genes and >30 recognised minor genes, but only account for 0.5mmHg each
polyfactorial - environmental factors

Question 9

What is the likely cause of hypertension at a vascular/physiological level?

Answer 9

• increased reactivity of resistance in arterioles. results in increased peripheral resistance. may be hereditary.
• some individuals kidney’s are unable to excrete a certain amount of sodium - water retention. furthered by arteriole defect

Question 10

What are some other attributable factors for hypertension?

Answer 10

• age bc elasticity and arteriole compliance,
• environmental stresses,
• weight,
• birth weight,
• race,
• alcohol

Question 11

How is race related to blood pressure?

Answer 11

afro/caribbean people have higher BP than caucasians, and those who live rurally have a lower BP. more sensitive to salt dietary changes.

Question 12

How do you assess and screen a patient for treatment?

Answer 12

• assess end organ damage - ECG, echocardiogram. renal ultrasound, renal function, proteinuria.
• screen for treatable causes - in secondary hypertension.

Question 13

How do you treat stage 1 hypertension?

Answer 13

only treat if risk is 10% of developing CVD in 10 years.
target is 135/80-85mmHg
if under 80 and has some comorbidity, start treatment. if over 80, treat but aim for higher BP - 145/85mmHG.
if under 40, find secondary disease

Question 14

How do you treat stage 2 hypertension?

Answer 14

don’t look for co-morbidities or age - just treat it

Question 15

What is step 1 in chosing a drug?

Answer 15

• if over 55/afro/caribbean, give CCB
• if under 55, give ACE inhibitors.
  not to child bearing age women - teratogenic or toxic to foetus

Question 16

What is step 2 in chosing a drug?

Answer 16

add thiazide type diuretic to step 1

Question 17

What is step 3 in chosing a drug?

Answer 17

give ACE, CCB’s and diuretics together

Question 18

What is step 4 in chosing a drug?

Answer 18

resistant despite 3 agents? higher dose diuretic or further diuretic therapy. consider compliance issues

Question 19

What are 4 types of anti-hypertensive drugs?

Answer 19

ACE inhibitors, CCB’s, thiazide type diuretics and angiotensin II receptor blockers

Question 20

What are 2 ACE inhibitors, their purpose and effects?

Answer 20

ramipril and perindopril. inhibits angiotensin production - its a vasoconstrictor. may lead to cough, renal dysfunction or renal artery stenosis

Question 21

What are 3 angiotensin II receptor blockers and its benefit?

Answer 21

losartan, valsartan, candesartan. no more benefits than ACE inhibitors, but more side effects.

Question 22

What are some CCB’s and the types?

Answer 22

• Vasodilators - amlodipine, felodipine
• rate limiting Ca2+ blockers - verapamil
• nifedipine in child bearing age

rate limiting are vasoconstricting too. act on myocytes to reduce HR.

Question 23

What are the side effects of CCB’s?

Answer 23

• flushing,
• headache,
• ankle oedema,
• indigestion,
• bradycardia and constipation (rate limiting).

Question 24

What is a thiazide type diuretic and its use?

Answer 24

indapamide. full effect may take weeks. can be used in combo with other drugs. first line in afro-carribean descent for mild/mid hypertension.

Question 25

What are special considerations of CCB’s?

Answer 25

• Don’t give to patients with MI or heart failure.
• In patients with bradycardia, use rate limiting.
• Give child bearing age nifedipine