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Cardio > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Phaeocromocytoma

A

Tumour of the adrenal gland

Paroxysmal secretion of catecholamines results in hypertension, palpitations, sweating, headache and anxiety

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2
Q

What is the value for hypertension?

A

140/90

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3
Q

Aetiological Classification

A

Primary - No obvious cause

Secondary - Underlying disease implicated

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4
Q

Clinicopathological Classification

A

Benign

Malignant

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5
Q

Factors contributing to primary hypertension

A 
Genetics
Salt intake 
Protein intake
RAAS 
Sympathetic activity
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6
Q

Causes of secondary hypertension

A 
Renal disease 
Obstructive Sleep Apnoea
Endocrine disease 
Aortic disease - e.g. coarctation of the aorta 
Renal artery stenosis 
Drug therapy - including corticosteroids
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7
Q

Renal causes of secondary hypertension

A

Any renal disease, especially renal artery stenosis and diabetic renal disease
Reduced renal blood flow -> excess renin release -> salt and water overload -> hypertension

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8
Q

Endocrine causes of secondary hypertension

A

Adrenal gland hyperfunction/tumours
Conn’s syndrome (excess aldosterone)
Cushing’s syndrome (excess corticosteroid)
Phaeochromocytoma (excess noradrenaline)

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9
Q

What is benign hypertension?

A

Asymptomatic hypertension

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10
Q

What are the complications of benign hypertension?

A 
Left ventricular hypertrophy 
Congestive cardiac failure 
Increased atheroma 
Increased aneurysm rupture (aortic dissection, Berry aneurysms) 
Renal disease
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11
Q

What is malignant hypertension?

A

Serious, life threatening in short term
Diastolic pressure >130-140
Developed from being primary or secondary hypertension, or rarely de novo

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12
Q

What are the complications of malignant hypertension?

A

Cerebral oedema
Acute renal failure
Acute heart failure
Headache and cerebral haemorrhage

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13
Q

If clinic BP is 140/90 mmHg, what is the next step of diagnosis?

A

Ambulatory blood pressure

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14
Q

When using ABPM to confirm hypertension, how often should measurements be taken?

A

At least two per hour during the patients normal waking hours (usually 14 per day)

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15
Q

When using HBPM to confirm hypertension, how often should measurements be taken?

A

Two consecutive seated measurement, 1 minuted apart
BP recorded x2 daily for at least 4 days, but preferably 7
Discard first day measurement and average the rest

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16
Q

Define Stage 1 Hypertension

A

Cinic BP =>140/90mmHg
AND
ABPM or HBPM daytime average =>135/85mmHg

17
Q

Define Stage 2 Hypertension

A

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

18
Q

Define Severe Hypertension

A

Clinic systolic BP => 180mmHg
OR
Clinic diastolic BP => 110mmHg

19
Q

Risk Factors for End Organ Damage

A 
AGE 
Left ventricular hypertrophy 
Creatinine raised 
Albuminuria/microabuminuria 
Retinopathy
Established vascular disease
20
Q

Target BP with drug treatment

A

Clinic BP
80y/o

White Coat Effect (ABPM/HBPM BP)
80y/o

21
Q

Hypertension Management - Lifestyle Interventions

A

Diet = reduce sodium and caffeine intake
Weight reduction and increased exercise
Reduce alcohol consumption
Quit smoking

22
Q

How much does BP drop for every kg lost?

A

1mmHg

23
Q

Which classes of drugs can be used as anti-hypertensives?

A 
Thiazide diuretics
ACE inhibitors/ARBs
Calcium channel blockers 
Beta blockers 
Spironolactone 
Alpha blockers
24
Q

Which anti-hypertensive is ideally suited in a patient who also has angina?

A 
Beta blockers 
(or calcium channel blockers)
25
Q

Which anti-hypertensives are ideally suited in a patient who also has CCF?

A

ACE inhibitors

Beta blockers

26
Q

Which anti-hypertensive is ideally suited in a patient who also has diabetic nephropathy?

A

ACE inhibitors/ARBs

27
Q

Which anti-hypertensive is ideally suited, with caution, in a patient who also has prostatism?

A

Alpha blockers

28
Q

Which anti-hypertensive is ideally suited in elderly patients?

A

Thiazide diuretics

29
Q

Antihypertensive Drug Treatment = Step 1 for

A

ACE inhibitor or low cost ARB

30
Q

Antihypertensive Drug Treatment = Step 1 for >55y/o or person of Afro-Carribean family origin

A

Calcium channel blocker

can use thiazide-like diuretic if CCB not tolerated

31
Q

Why might a CCB not be tolerated?

A

Oedema
Evidence of heart failure
High risk of heart failure

32
Q

Antihypertensive Drug Treatment = Step 2

A 
ACE inhibitor (or low cost ARB)
\+ CCB (or thiazide-like diuretic if CCB not tolerated)
33
Q

Antihypertensive Drug Treatment = Step 3

A

Review medication to ensure optimal or best tolerated dosage

ACE inhibitor (or low cost ARB) + CCB + Thiazide-like diuretic

34
Q

Antihypertensive Drug Treatment = Step 4

A

A + C + D
Consider further diuretic treatment, spironolactone, alpha blocker or beta blocker
Seek expert advice

35
Q

What are the advantages to combination therapy?

A

Fewer side effects than mono therapy

Gives a greater reduction in BP than mono therapy

36
Q

What factors might explain resistant hypertension?

A 
Non-concordance 
White Coat Effect
Pseudo-hypertension
Lifestyle factors 
Drug interactions 
Secondary hypertension 
True resistance
37
Q

What is the most effective treatment for resistant hypertension?

A

Spironolactone

38
Q

How should spironolactone be given?

A

Start low go slow

Caution in diabetes and low GFR

39
Q

In young women, what may ACE inhibitors be replaced with, and why?

A

Beta Blockers

Risk of foetal toxicity

Cardio (19 decks)

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