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CVS Pathology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Stages of HTN in terms of clinical BP

A

Stage 1 - > 140/90
Stage 2 - > 160/100
Severe - >180/110

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2
Q

Stages of HTN in terms of ABPM daily average

A

Stage 1 - >135/85

Stage 2 - 150/95

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3
Q

What % of HTN has an identifiable cause?

A

5 - 10%

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4
Q

What does sustained HTN produce?

A

End organ damage to blood vessels, heart and kidney

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5
Q

Causes of secondary HTN

A 
Renal disease
Drug induced 
Pregnancy 
Endocrine causes
Vascular 
Sleep apnoea
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6
Q

What renal diseases can cause secondary HTN?

A

Chronic pyelonephritis
Fibromuscular dysplasia
Renal artery stenosis
Polycystic kidneys

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7
Q

What drugs can cause HTN?

A

NSAIDs
Oral contraceptives
Corticosteriods

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8
Q

What condition in pregnancy is especially associated with HTN?

A

Pre eclampsia

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9
Q

What endocrine conditions can cause secondary HTN?

A 
Conns syndrome 
Cushings disease
Phaechromocytoma 
Hypo and hyperthyroidism 
Acromegaly
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10
Q

What vascular condition can especially cause HTN?

A

Coarctation of the aorta

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11
Q

What non modifiable factors does BP tend to increase with?

A

Age
Genetics
FH
Race (afrocarribean)

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12
Q

What in the environment can increase your BP?

A

Stress

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13
Q

What can raise BP?

A

Co morbidities
Age
Weight (sodium intake and diet)
Alcohol intake

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14
Q

Relationship between birth weight and HTN

A

Lower the birth weight, higher the likelihood of developing HTN and heart disease

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15
Q

Definition of primary HTN

A

HTN where there is no identifiable cause

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16
Q

Definition of secondary HTN

A

HTN where there is an identifiable cause

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17
Q

What % of cases are primary HTN?

A

95%

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18
Q

What % of cases are secondary HTN?

A

5 - 10%

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19
Q

Risk factors for HTN

A 
Smoking
DM
Renal disease
Male
Hyperlipidaemia 
Previous MI or stroke 
LVH
Sedentary lifestyle
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20
Q

What are the prime contributors to BP?

A

Cardiac output
- SV
- HR
Peripheral vascular resistance

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21
Q

What does the sympathetic nervous system activation cause?

A

Vasoconstriction
Reflex tachycardia
Increased cardiac output
= INCREASED BP

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22
Q

What is pivitol in long term blood pressure control?

A

RAAS

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23
Q

What does RAAS stand for?

A

Renin angiotensin aldosterone system

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24
Q

The RAAS is responsible for what?

A

Maintenance of sodium balance
Control of blood volume
Control of BP

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25
Q

What is the RAAS stimulated by?

A

Fall in BP
Fall in circulating volume
Sodium depletion

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26
Q

What happens when RAAS is stimulated?

A
  1. Renin release from juxtaglomerular apparatus
  2. Renin converts angiotensin to angiotensin I
  3. Angiotensin I is converted to angiotensin II by angiotensin converting enzyme (ACE)
  4. Angiotensin II constricts, and stimulates aldosterone release from adrenal glands
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27
Q

What does angiotensin II do?

A

Potent

  • vasoconstrictor
  • anti natriuretic peptide
  • stimulator of aldosterone release from the adrenal glands
  • hypertrophic agent which stimulates myocyte and smooth muscle hypertrophy in the arterioles
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28
Q

What does aldosterone do?

A

Potent

  • anti-natriuretic peptide
  • antidiuretic peptide
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29
Q

What are poor prognostic indicators in patients with HTN?

A

Myocyte and smooth muscle hypertrophy

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30
Q

Examples of end organ damage that HTN can cause

A 
Retinopathy 
Peripheral vascular disease
Coronary heart disease
Heart disease
Renal failure
Proteinuria 
Stroke
Cognitive decline
LVH
MI
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31
Q

HTN treatment goal elderly vs young people

A

Elderly target BP is higher than in young people

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32
Q

How may HTN be identified?

A

ABPM ambulatory blood pressure monitoring

HBPM home blood pressure monitoring

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33
Q

How do we assess renal function?

A

eGFR

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34
Q

How do we assess cardiac function?

A

ECG

ECHO

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35
Q

What treatable causes of HTN must be screened for?

A

Renal artery stenosis / FMD
Cushings disease
Conns syndrome
Sleep apnoea

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36
Q

What should be an ideal target BP to be obtained on treatment?

A

< 135/80-85mmHg

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37
Q

When should treatment for BP be started?

A

Overall CVD risk of 20% / 10 years

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38
Q

What should be used to treat young for HTN?

A

ACE inhibitor

ARB

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39
Q

Do the young have high or low renin?

A

High

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40
Q

What should be used to treat the elderly for HTN?

A

CCBS

Thiazide type diuretic

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41
Q

Do the elderly have high or low renin?

A

Low

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42
Q

Who should ACE inhibitors / ARBs not be used in in the young group?

A

Young women

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43
Q

Who should the treatment for stage 1 HTN be given to?

A

If < 80 y/o with ABPM > 135/80 with 1 or more of
- target organ damage
- established CVD
- Renal disease
- DM
- 10 yr CV risk equivalent to 20% or greater
If < 40 y.o get specialist advise

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44
Q

What BP is stage 1 HTN?

A

ABPM > 135 / 85

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45
Q

What BP is stage 2 HTN?

A

ABPM > 150 / 95

46
Q

Who should the treatment for stage 2 HTN be given to?

A

Any people of any age with stage 2 HTN - the risk does not matter here

47
Q

Treatment for HTN for > 55 y/o or black people of any age

A

CCB

TTD if oedema / intolerance / HF

48
Q

Treatment for HTN for < 55 y/o

A

ACEI or ARB

49
Q

Why do afro-carribeans not get treated with ACEIs/ARBs?

A

Susceptible to swelling of the epiglottis/face

50
Q

Step 2 treatment for HTN

A

Add TTD to CCB or ACEI/ARB

51
Q

Step 3 treatment for HTN

A

Add the other drug that you haven’t used - so add CCB, ACEI and diuretic together

52
Q

Treatment for resistant HTN

A

Low dose spironolactone (25mg once daily) if blood K+ is <4.5mmol/l
TTD if blood K+ is over 4.5mmol/l

53
Q

Why should treatment with spironolactone be cautioned with in reduced eGFR?

A

They have an increased risk of hyperkalaemia

54
Q

Examples of ACEIs

A

Ramipril

Perindopril

55
Q

What does ACEIs stand for?

A

Angiotensin converting enzyme inhibitors

56
Q

What do ACEIs do?

A

Completely inhibit actions of angiotensin converting enzyme (ACE)

57
Q

Contraindications to ACEIs

A

Renal artery stenosis
Renal failure
Hyperkalaemia

58
Q

Adverse drug reactions of ACEIs

A 
Cough
1st dose HTN
Taste disturbance
Renal impairment
Hyperkalaemia
Angioneurotic oedema
59
Q

Drug drug interactions of ACEIs

A

NSAIDs
Potassium supplements
Potassium sparing diuretics

60
Q

What would ACEIs and NSAIDs together result in?

A

Precipitation of acute renal failure

61
Q

What would potassium supplements and potassium sparing diuretics with ACEIs result in?

A

Hyperkalaemia

62
Q

Examples of ARBs

A

Losartan
Valsartan
Candesartan
Irbesartan

63
Q

What do ARBs stand for?

A

Angiotensin II antagonists

64
Q

What do ARBs do?

A

Competitively block the actions of angiotensin II at the angiotensin AT1 receptor

65
Q

Why do ARBs have an advantage over ACEIs?

A

They do not cause a cough

66
Q

What is the most effective ARB?

A

Losartan

67
Q

Types of CCBs

A

Vasodilators

Rate limiting

68
Q

Examples of vasodilator CCBs

A

Amlodipine

Felodipine

69
Q

Examples of rate limiting CCBs

A

Verapamil

Diltiazem

70
Q

How do CCBs work?

A

Block the L type calcium channels
Selectivity between vascular and cardiac L type channels
Relaxing small and large arteries and reducing peripheral resistance
Reducing CO

71
Q

Who are vasodilator CCBs the antihypertensive of choice in?

A

> 55 y/o

Women of child bearing age

72
Q

Contraindications of CCBs

A

Acute MI
Heart failure
Bradycardia (rate limiting CCBs)

73
Q

S/Es of CCBs

A

Flushing
Headache
Ankle oedema
Indigestion and reflux oesophagitis

74
Q

What do rate limiting CCBs also cause?

A

Bradycardia

Constipation

75
Q

Examples of TTDs

A

Indapamide

Clortalidone

76
Q

Who is TTDs commonly the 1st line treatment in?

A

Mild - moderate HTN in afro-carribeans

77
Q

How do TTDs work?

A

Block reabsorption of sodium and enhance urinary sodium loss

78
Q

The full effects of TTDs as anti-HTNs may take how long?

A

Weeks

79
Q

S/Es of TTD

A

(Not common)
Gout
Impotence
Hypokalaemia

80
Q

Centrally acting agents like methyldopa can cause what?

A

Depression

81
Q

Examples of vasodilators

A

Hydralazine

Minoxidil

82
Q

S/Es of vasodilators

A

Dry mouth

Bad dreams

83
Q

Effects of NSAIDs

A

Salt and water retention - causing increased BP

Shuts off prostaglandin production

84
Q

What causes a displaced apex?

A

LVH

85
Q

What does LVH stand for?

A

Left ventricular hypertrophy

86
Q

What else can be looked for in LVH?

A

4th heart sound - diastolic knock

87
Q

What murmur causes a collapsing pulse?

A

AR

88
Q

How should BP be checked?

A

Lying
Standing
Both sides

89
Q

Man with HTN aged 48 y/o, what investigations should be done?

A 
U and Es (esp Na+ and K+)
Lipids
Urine dipstick 
LFTs
Thyroid
Glucose
ECG
ECHO 
Kidneys/adrenal glands via USS
90
Q

Potassium level in conns syndrome

A

Decreases

91
Q

Potassium level in phaeochromocytoma

A

Increases

92
Q

What does acute alcohol intake do to BP?

A

Decreases BP

93
Q

What does chronic alcohol do to BP?

A

Increases BP

94
Q

If BP >140/90, what should be offered to confirm the diagnosis?

A

ABPM

95
Q

LVH on ECG

A

S wave on V2 and V5 added together, if > 30mm = LVH

96
Q

S/Es of alpha blockers

A

Postural hypotension

HF

97
Q

Contraindication to alpha blockers

A

Urinary incontinence

98
Q

When should there be a caution in using BBs?

A

DM

99
Q

S/Es of ARBs

A

Hyperkalaemia

100
Q

S/Es of spironolactone

A

Hyperkalaemia

101
Q

What treatment should be added onto poorly controlled HTN already on an ACEI, CCB and a standard dose TTD with a K > 4.5mmol/l?

A

Alpha or beta blocker

102
Q

What do ACEIS cause (in terms of electrolytes) as a S/E?

A

Hyperkalaemia

103
Q

What do diuretics’ cause (in terms of electrolytes) as a S/E?

A

Hypokalaemia

104
Q

BP target for a clinic reading and < 80 y/os

A

< 140 / 90

105
Q

Max dose of amlodipine

A

10mg

106
Q

Max dose of ramipril

A

5mg

107
Q

If a patient cannot tolerate and ACEI due to the S/Es, what should be done to the medication?

A

Stop the ACEI

Change to an ARB

108
Q

Give an example of an ARB

A

Candesartan

109
Q

1st line treatment for a newly diagnosed patient with HTN who has T2DM

A

ACEI or ARB - REGARDLESS of age

110
Q

Pharmacological options for treatment of orthostatic hypotension

A

Fludrocortisone

Midodrine

111
Q

Treatment of orthostatic hypotension

A
  1. Lifestyle measures - increased Na and H20 intake
  2. Discontinuation of vasoactive drugs e.g. nitrates, anti-HTNs, neuroepileptic agents, dopaminergic drugs
  3. If symptoms persist, consider compression garments, fludrocortisone, midodrine, counter pressure manouvres, head up tilt sleeping
112
Q

Target BP for a T1DM who has HTN, but no albuminuria

A

< 135/85

CVS Pathology (19 decks)

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