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Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what is hypertension?

A

a disorder in which the level of sustained arterial pressure is higher than expected for the age, sex and race of the individual

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2
Q

what is the exact blood pressure considered to be hypertension?

A

> 140/90

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3
Q

what are the two types of hypertension?

A

white coat

stable or labile

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4
Q

what does hypertension eventually cause?

A

cardiac failure

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5
Q

what is hypertension a risk factor for?

A

cerebral haemorrhage
atheroma
renal failure
sudden cardiac death

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6
Q

describe the incidence of hypertension

A 
varies between countries
higher in black populations 
lower in south pacific 
familial tendency 
rises with age
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7
Q

what is the classification of hypertension according to cause?

A

primary or secondary

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8
Q

what is the classification of hypertension according to consequences?

A

benign or malignant

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9
Q

how can BP be calculated?

A

CO X PR

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10
Q

what has an effect on CO?

A

HR
contractility
blood volume

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11
Q

what has an effect on PR?

A

constrictors and dilators

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12
Q

describe resistance arteries

A

peripheral resistance

target organ damage

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13
Q

what is primary hypertension?

A

most common

no obvious cause

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14
Q

what can be involved in causing primary hypertension?

A

genetic factors
salt intake
protein intake

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15
Q

which body systems does primary hypertension involve?

A

RAAS

sympathetic activity

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16
Q

what is salt sensitive hypertension?

A

increase in dietary salt leads to increase in BP
some causes primary hypertension
controlled by reduced salt diet

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17
Q

what causes salt sensitive hypertension?

A

genetic polymorphisms

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18
Q

what is secondary hypertension?

A

when underlying disease is implicated eg renal disease, endocrine disease, aortic disease, renal artery stenosis, drug therapy

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19
Q

what are renal causes of hypertension?

A

any renal disease
reduced renal blood flow
excess renin release
salt and water overload

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20
Q

name some renal diseases which may cause hypertension

A

renal artery stenosis, acute or chronic glomerulonephritis, chronic pyelonephritis, cystic diseases, interstitial nephritis

21
Q

what are endocrine causes?

A

adrenal gland hyperfunction/tumours
eg conn’s syndrome- excess aldosterone, cushing’s syndrom- excess corticosteroid, phaeochromocytoma- excess noradrenaline

22
Q

what are other causes?

A

coarctation of the aorta- congenital narrowing of segments of the aorta
drugs- including corticosteroids

23
Q

what is benign hypertension?

A

a cause of serious life threatening morbidity

asymptomatic, incidental finding often health checks

24
Q

what does benign hypertension eventually cause?

A 
left ventricular hypertrophy 
congestive cardiac failure 
increases atheroma 
increases aneurysm rupture- aortic dissection, Berry aneurysms 
renal disease
25
Q

what happens during left ventricular hypertrophy?

A 
increased LV load
poor perfusion
interstitial fibrosis 
micro-infarcts 
diastolic dysfunction
26
Q

what can LV hypertrophy cause?

A

sudden cardiac death- arrhythmia and poor perfusion
cardiac failure
affects outcome of other disease

27
Q

what is a subrachnoid haemorrhage?

A

rupture of berry aneurysm

28
Q

what are the figures of benign hypertension?

A

Every 10mmHg of diastolic pressure above 85 doubles risk of MI
Every 8mmHg of diastolic pressure above 85 doubles risk of stroke

29
Q

what is microvascular injury?

A

blood vessel wall changes- small arteries and arterioles
thickening of media (smooth muscle)
hyaline arteriosclerosis

30
Q

where can microvascular injury occur?

A

retina and kidneys

31
Q

what is hyaline arteriosclerosis?

A

plasma proteins forced into vessel wall

32
Q

what is malignant hypertension?

A

serious life threatening condition
diastolic presssure > 130-140
needs urgent treatment to prevent death

33
Q

how does malignant hypertension arise?

A

from either primary or secondary hypertension or arise de-novo

34
Q

what does malignant hypertension cause?

A 
cerebral oedema- papilloedema
acute renal failure
acute heart failure 
headache and cerebral haemorrhage 
blood vessels show fibrinoid necrosis and endarteritis proliferans of their walls
35
Q

what is pregnancy associated hypertension?

A

pre-eclampsia- hypertension and proteinuria

hypertension secondary to silent renal or systemic disease

36
Q

what is stage 1 hypertension?

A

clinic BP is 140/90 mmHg or higher and ABPM or HBPM daytime average is 135/85 mmHg or higher

37
Q

what is stage 2 hypertension?

A

clinic BP 160/100 mmHg or higher and ABPM or HBPM daytime average is 150/95 mmHg or higher

38
Q

what is severe hypertension?

A

clinic BP is 180 mmHg or higher or clinic diastolic BP is 110 mmHg or higher

39
Q

what is the main driver for absolute risk of hypertension?

A

age

40
Q

what is the end organ damage of hypertension?

A

LV hypertrophy
creatinine raised
albuminuria/ microalbuminurira
retinopathy

41
Q

what drugs are used to treat hypertension?

A

ACE inhibitors
Beta blockers
Calcium channel blockers
Diuretics (usually thiazide)

42
Q

what is the benefit of combination therapy?

A

fewer side effects

43
Q

what are the characteristics of resistant hypertension?

A 
non-concordance
'white coat' effect 
pseudo-hypertension
lifestyle factors
drug interactions
secondary hypertension
true resistance
44
Q

which drug is the most effective in treating resistant hypertension?

A

spironolactone

45
Q

describe the use of spironolactone

A

start low; go slow

caution: diabetes and low GFR

46
Q

describe the treatment of hypertension in under 55s

A

ACE/ARB or B-blocker if fertile female, calcium antagonist, diuretic, spironolactone

47
Q

describe the treatment of hypertension in over 55s

A

calcium antagonist, ACE/ARB, diuretic, spironolactone

48
Q

what new technologies can be used to treat hypertension?

A

renal denervation
baro-receptor stimulation
rox coupler

Cardiovascular (31 decks)

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