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1st year systems > aetiology, pathology and treatment of hypertension > Flashcards

aetiology, pathology and treatment of hypertension Flashcards

1
Q

whats the worlds number one cause of preventable morbidity and mortality?

A

hypertension

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2
Q

whats the UK number 1 preventable cause of premature mortality and morbidity?

A

hypertension

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3
Q

what are the compliations of hypertension (the affect on organs)?

A

brain:
haemorrhage, stroke, cognitive decline

eyes:
retinopathy

peripheral:
peripheral vascular disease

renal:
renal failure, dialysis, transplantation, proteinuria

heart:
coronary heart disease, congestive heart failure, left ventricular hypertophy

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4
Q

whta stresses effect blood pressure?

A

physical and mental

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5
Q

definition of hypertension?

A

That blood pressure above which the benefits of treatment outweigh the risks in term of morbidity and mortality

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6
Q

what is the BP and ABPM of a patient that is suffereing from stage 1 hypertension?

A

BP: 140/90
ABPM: 135/85

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7
Q

what is the BP and ABPM of a patient that is suffereing from stage 2 hypertension?

A

BP: 160/100
ABPM: 150/95

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8
Q

what is the BP and ABPM of a patient that is suffereing from severe hypertension?

A

systolic BP ois 180

diastolic BP is 110

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9
Q

how much of cases have not found a cause (primary hypertension?

A

90%

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10
Q

what are secondary hypertensions

A

a cause for hypertension for e.g.
chronic renal disease
renal artery stenosis
endocrine disease, cushings, conns syndrome,

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11
Q

what are risk factors of increasing the chnce of hypertension?

A 
Cigarette smoking		
Diabetes mellitus
Renal disease
Male				
Hyperlipidaemia		
Previous MI or stroke	
Left ventricular hypertrophy
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12
Q

what controls blood pressure?

A

an integrated system

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13
Q

what are the prime contributers to blood pressures?

A

cardiac output- stroke volume, heart rate

peripheral vascular resistance

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14
Q

what does the sympathetic nervous system activation produce?

A

vasocontriction
reflex tachycardia
increased cardiac output

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15
Q

does the sympathetic nervous system activation increase blood pressure or decrease?

A

increase

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16
Q

what is The Renin-Angiotensin-Aldosterone System responsible for?

A

maintenance of sodium balance
control of blood volume
control of blood pressure

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17
Q

what is the RAAS stimulated by?

A

fall in BP
fall in circulating volume
sodium depletion

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18
Q

what does renin convert angiotensinogen to?

A

angiotensin I

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19
Q

what converts angiotensin I to angiotensin II?

A

angiotensin converting enzyme (ACE)

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20
Q

whats the function of angiotensin II?

A

vasoconstrictor

anti- natriuretic peptide

stimulator of aldosterone release from the adrenal glands

21
Q

whats the aetiology of hypertension?

A

Increased reactivity of resistance vessels and resultant increase in peripheral resistance

A sodium homeostatic effect

Age
Genetics and family history
Environment
Weight
Alcohol intake
Race
22
Q

will removing the cause of hypertension decrease the risk or return back to normal?

A

not necessarily

23
Q

causes for secondary hypertension?

A

Renal disease: 20% of resistant hypertension

Drug Induced

Pregnancy

Endocrine

Vascular

Sleep Apnoea

24
Q

what things would be assessed when determining the risk of hypertension?

A 
Previous MI, stroke, IHD
Smoking
Diabetes mellitus
Hypercholesterolaemia
Family history
Physical Examination

Assess end organ damage

Screen for treatable causes

25
Q

why do we treat hypertension?

A

reduce cerebrovascular disease by 40-50%

reduce MI by 16-30%

26
Q

how do you treat stage 1 hypertension?

A

Offer antihypertensive drug treatment to people aged under 80 years with ABPM >135/85 with one or more of the following:
target organ damage
established cardiovascular disease
renal disease
diabetes
a 10-year cardiovascular risk equivalent to 20% or greater.

27
Q

how do you treat stage 2 hypertension?

A

ABPM> 150/95

Offer antihypertensive drug treatment to people of any age with stage 2 hypertension.

28
Q

whats the first step for choosing antihypertensive druug treatment?

A

Offer step 1 antihypertensive treatment with a calcium-channel blocker (CCB) to people aged over 55 years and to black people of African or Caribbean family origin of any age.

If a CCB is not suitable (oedema, intolerance), or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.

29
Q

whats the second step for treatment for hypertension?

A

Add Thiazide-type diuretic such as clortalidone or indapamide to CCB or ACEI/ARB

30
Q

step 3 for treatment of hypertension?

A

Add CCB, ACEI, Diuretic together

31
Q

treatement of resistant hypertension

A

Consider further diuretic therapy with low-dose spironolactone (25 mg once daily) if the blood potassium level is 4.5 mmol/l or lower.
caution in people with a reduced estimated GFR because they have an increased risk of hyperkalaemia.
Consider higher-dose thiazide-like diuretic treatment if the blood potassium level is higher than 4.5 mmol/l. [new 2011]

32
Q

what inhibits the actions of angiotensin converting enzyme?

A

RAMIPRIL

33
Q

what is the function of angiotensin converting enzyme?

A

converts angiotensin I to active angiotensin II which is a potent vasoconstrictor and hypertetrophogenic agent

34
Q

what plays a significant role in organ damage?

A

angiotensin II

35
Q

what are the contraindications of angiotensin II?

A

Renal artery stenosis
Renal failure
Hyperkalaemia

36
Q

what are the adverse reactions of angiotensin

A 
cough
first dose hypotension
taste disturbance
renal impairment
angioneurotic oedema
37
Q

what is the function of calcium channel blockers?

A

vasodilator and rate limiting

38
Q

CCB work by…

A

blocking the L type calcium channels

selectivity between vascular and cardiac L type channels

relaxing large and small arteries and reducing peripheral
resistance

reducing cardiac output

39
Q

who should you give CCBs to?

A 
over 55years. 
women of child baring age 
Compliance is high, 
Benefit in the elderly patient with systolic
Hypertension
Rarely cause postural hypotension
40
Q

what are contraindications of CCBs

A

Acute MI

Heart failure, bradycardia (rate limiting CCBs)

41
Q

what are adverse drug reactions of CCBs

A

Flushing
Headache
Ankle oedema
Indigestion and reflux oesophagitis

42
Q

what drug should you gibe to afro-caribbean?

A

thiazide

Indapamide, Clortalidone

43
Q

whats the function of doxazosin?

A

Selectively block post synaptic 1-adrenoceptors

Oppose vascular smooth muscle contraction in arteries

44
Q

what are the adverse reactions of doxazosin?

A

First dose hypotension
Dizziness
Dry mouth
Headache

45
Q

what drug should you use for pregnant people?

A

METHYLDOPA

46
Q

what are adverse reactions of methyldopa?

A

Sedation and drowsiness
Dry mouth and nasal congestion
Orthostatic hypotension

47
Q

what is the treatment regime for hypertension if over 55 years?

A 
If over 55years of age
Start 	CCB
No or incomplete effect
Add 	Thiazide-type diuretic
Incomplete effect
Add 	ACE inhibitor
Still incomplete effect
Add 	Beta-blocker
Still incomplete effect
Add one of the less commonly used agents
48
Q

what is the treatment regime for hypertension if young?

A 
Start 	ACEI
If child bearing age CCB or Beta Blocker
No or incomplete effect
Add 	Thiazide type diuretic
Incomplete effect
Add 	Calcium channel blocker
Still incomplete effect
Add 	Beta-blocker
Still incomplete effect
Add one of the less commonly used agents
49
Q

what is the second most comon cause of maternal and fetal death?

A

hypertension

1st year systems (74 decks)

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