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hypertension Flashcards

1
Q

what does a 2mmHg rise in blood pressure lead to

A

7% - increase risk of mortality for IHD (ischemic heart disease)

10% - increase risk mortality from stroke

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2
Q

what is special about the treatment of hypertension

A

it is the most cost effective treatment ever reviewed

roughly £30 per year

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3
Q

what are the complications of hypertension on organs (late stage)

A

brain - stroke, haemorage, cognitive decline

retinopathy - eye damage

reanaly failure, dialysis

peripherial vascular disease

heart - Left ventrical failure, coronary heart disease, congestive heart failure, MI

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4
Q

what is the definition of hypertension

A

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

very personal per person

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5
Q

what is the rough guide for when a patient is hypertensive

A

140/90

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6
Q

what is the optimum - why is this important

A

<120/<80

this should be the target for young people

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7
Q

what is stage 1 hypertension

A

clinic reading 140/90

ambulatory blood pressure monitoring - 135/85

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8
Q

what is stage 2 hypertension

A

clinic reading 160/100

ABPM - 150/95

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9
Q

what is severe hypertension

A

when systolic pressure is 180 or higher

when diastolic is 100 or higher

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10
Q

what is primary hypertension - what percentage of cases is this

A

hypertension that doesn’t have a secondary cause

90% of cases

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11
Q

what are the casues of 2econdary hypertension - percentage

A

5-10% of cases secondary hypertension

chronic renal disease
renal artery stenosis
endocrinde disease
cushings
conns syndrome
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12
Q

how many deaths does hypertension cause

A

no 1 killer

> 20% of deaths are directly/indirectly related

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13
Q

why do people who have hypertension and are under 40 see a specalits

A

as there is often a underlying cause

and its a secondary hypertension diagnosis

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14
Q

what factors increase the likely hood of hypertension

A 
ciggaret smoke 
diabetes mellitus 
renal disease
male 
hyperlididaemis 
previous MI or stroke 
Left ventricular Hypertrophy 
fitness
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15
Q

what is diabetes mellitus

A

a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.

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16
Q

what factors contribute to blood pressure

A

CO - cardiac out put
SV - stroke volume
HR - heart rate
TPR - total peripheral resistance

drugs can target each of these factors

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17
Q

what accounts for second to second blood pressure changes

A

sympathetic system

  • vasocontstiction
  • reflex tachycardia
  • increased cardiac output
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18
Q

what is pivotal in long term blood pressure control

A

the renin-angiotensisn-aldosterone system

RAAS

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19
Q

what is the retin-angiotension-aldosterone system responsible form

A

mananing Na balance

control of blood volume

controll of blood pressure

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20
Q

what is the RAAS stimulated by

A

fall in BP

fall in circulating volume

sodium depletion

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21
Q

what happens once the RAAS system is stimulated

A

renin is released from the juxtaglomerular apparatus (kindey bulitding blocks)

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22
Q

what is the function of renin

A

to conver angiotensinogen to angiotensin 1

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23
Q

what does angiotensin 1 do

A

it is converted into angiotensisn 2 converting enzyme (ACE - ahhhhhhh!)

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24
Q

what is angiotensin 2

A

its a potent vasoconstrictor

anti-naturiuretic peptide (reduces overfilled ECF volume by increasing renal sodium excretion)

simulator of aldosterone release form the adrenal glands

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25
Q

when the RAAS is stimulated what does this mean

A

that there is a drop in BP

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26
Q

how does angiotensin 2 effect the arterioles

A

its a potent hypertophic agent (makes cells big) which stimulates myocyte and smoothe muscle hypertrophy in the arterioles

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27
Q

what is the function of aldosterone

A

its a potent anti-naturutetic

and anti-deretic (retain water)

28
Q

what are myocyte and smooth muscle hypertrophy

A

poor prognostic indicators in hypertensive patients

explains the risks from hypertension stay after treatment

29
Q

the aetiology of hypertension is

examples?

A

polygenic

  • genes (GRA, angiotensinogen)
  • poly genes (race, obesity)

polyfactorial

  • oral contraceptives
  • stress
  • lower education
30
Q

what other factors effect hypertension

A 
age 
faliy genetics
environment
weight 
alchol
race
31
Q

what should the treatment of hypertension generally be

A

AGRESSIVE

but be pragmatic - if the elderly cant withstand the treatment don’t give it to them

32
Q

what is the best link between family membrers to suggest genetics plays a factor in BP

A

the cosest correlation exists between siblings

rather than parent to child

33
Q

what effects does alcholo have on BP

A

small amounts = lowers BP

largere amounts = rasies BP

34
Q

what is 30% of hypertension attributed to

A

obesity - more likely to have sleep aponea - cause hypertension

35
Q

what factors does bith weight have on hypertension

A

the lower the birth weigh the greater chance of hypertension

36
Q

what effects does race have on BP

A

caucasioan have a lower BP than black populations living in the same environments

37
Q

what drugs can induce secondary hypertension

A

NSAIDS - nonsteroidal antiinflammatory drugs

oral contraceptions
cortocsteroids

38
Q

what pregnancy related illness can cause hypertension

A

pre-eclampsia

39
Q

what aortic defect can lead to hypertension

A

coarctation of the aorta

40
Q

what are the steps in diagnosis of hypertension

A

identify true hypertension = using ambulatory blood pressure monitor

assess risk

asses end organ damage

screen for treatable causes

41
Q

what are the steps of treatment

A

set target - <135/80-85 mmHg (depends om patient should be lower for younger patients)

42
Q

how do we treat hypertension

A

stepped approach

use low doses of several drugs - minimuses adverse effects

slow reduction to stop fainting and other problems

43
Q

what should you treat the elderly (low renin) with

A

calcium channel blocker

then thiazide-like diuretic if there is heart failure, oedema, intolerance

44
Q

what should you treat young individuals (high renin) with

A

ACE inhibitors/ ARB

45
Q

what peple should treatment not be offered to if they have stage 1 hypertension

A

people over the age of 80 - they are doing just fine

46
Q

how should not get ACE inhibitors

A

afro-caribean people

females of child bearing age (could lead to tertarogenisi)

47
Q

if the ACE inhibitor/ARB or CCB is not getting the desired effect what should you do - then whaty

A

add thiazide-like diuretic

if that dosent help add all 3 together

48
Q

2 examples of thiazide-like diuretic

A

chlortalidone

indapamide

49
Q

what should be used for resistant hypertension

A

low dose spironolactone (careful about K)

higher dose thiazide-like diuretic

50
Q

what is an example of a ACE inhibitor

A

Ramipril

51
Q

when should ACE inhibitors not be used

A

Renal artery stenosis
Renal failure
Hyperkalaemia

52
Q

what are ARBs

A

angiotensin 2 antagonists

53
Q

what are some examples of ARBs

A

losartan , valsartan

54
Q

vasodilating CCBs are the hypertensive of choice in which populations

A

people over 55 years old

women of child bearing age

55
Q

what are examples of vasodilationg CCBs

A

amlodipine/felodipine

56
Q

what are exampels of rate limiting CCBs

A

verapamil

diltiazem

57
Q

how do CCBs work

A

blocking the L type calcium channels

reducing TPR by relaxing arteries

reducing CO

58
Q

when should CCBs not be used

A

acute MI

heart failure, bradycardia (rate limiting CCBs)

59
Q

what side effects occur due to rate limiting CCBs

A

bradycardia

constibation

60
Q

what are exampels of thiazide type diuretics

A

INDAPAMIDE

clortalidone

61
Q

when are thiazide type diuretics used

A

the first line treatment in mild-moderate hypertension in Afro-Caribbean

in combination with anyother antihypertensive

62
Q

what is important to know aboyt thiazide type diuretics

A

antihypertensive effect may take weeks

63
Q

if a women is of child bearing age what should be prescribed

A

CCB or beta blocker

64
Q

what is hypertension in relation to pregnancy

A

the second most common cause of fetal and maternal death

65
Q

what is the treatmen for pregnant woment

A

PRE PREGNANCY atenolol (beta blocker)

then during pregnancy add thiazide diuretic

cardiovascular (26 decks)

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