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Hypertensiona > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Definition of hypertension

A

a blood pressure which is associated with significant cardiovascular risk and treatment is beneficial

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2
Q

Major varieties of hypertension

A

primary/central (95%) - no single obvious cause

secondary - some other medical condition which causes it

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3
Q

Causes of secondary hypertension

A 
renal disease, renovascular disease
Conn's syndrome, Cushing's syndrome
hyperthyroidism
phaeochromocytoma
pregnancy
drugs - NSAIDs, corticosteroids, sympathomimetics
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4
Q

Which organ is the main control of BP?

A

kidneys

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5
Q

Conn’s syndrome

A

excess aldosterone produced

causes increased sodium retention and therefore increased BP

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6
Q

Cushing’s syndrome

A

excess corticosteroids

sodium retention, augment sympathetic NS

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7
Q

Hyperthyroidism

A

excess thyroid hormone increases SNS

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8
Q

Phaeochromocytoma

A

young p
severely hypertensive
tumour secreting NA and adrenaline

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9
Q

Causes of primary hypertension

A 
obesity
insulin resistance
XS alcohol
genetics - activity of RAAS
environment
fetal programming eg. low birth weight
salt sensitivity
age 
ethnicity
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10
Q

How does obesity cause hypertension?

A

production of

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11
Q

How does insulin resistance cause hypertension?

A

metabolic syndrome, resistant to insulin

type II diabetes

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12
Q

Goals of treatment

and why?

A

control BP with as few side effects as possible
generally no symptoms of hypertension (if benefits outweigh SEs)
keep SBP <140; DBP <80
reduction in CV damage, preservation of renal function, limitation or reversal of LV hypertrophy, prevention of THD, reduction in mortality due to stroke and MI

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13
Q

Drugs used to treat hypertension

A 
ACEIs
AT1 receptor antagonists
calcium channel blockers
diuretics
alpha-blockers
beta-blockers
centrally acting antihypertensives
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14
Q

How do ACEIs treat hypertension?

A

inhibits conversion of angiotensin I to II
prevent vasoconstriction - reduces TPR
prevents production of aldosterone - reduces sodium and water retention

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15
Q

Side effect of ACEIs

A

potentiate bradykinin - cough
hyperkalaemia - increased K
severe first dose hypotension

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16
Q

What is contraindicated with ACEIs?

and why?

A

renovascular diease - bilateral renal artery stenosis
BP is very RAAS-dependent
ACEIs cause substantial drop in BP
potentially causing kidney failure
pregnancy - angiotensin II involved in vascular and renal development of fetus

17
Q

What are ACEIs effective for (besides hypertenstion)?

A

prevention of diabetic nephropathy - slows down renal damage

therefore ACEIs are best choice for ps with diabetes and hypertension

18
Q

How do AT1 receptor anntagonists treat hypertension?

A

block action of angiotensin II at AT1 receptor

therefore prevents vasoconstriction and production of aldosterone

19
Q

Why might AT1 receptor antagonists be preferred over ACEIs?

A

they are less likely to cause a cough

20
Q

How do calcium channel blockers treat hypertension?

A

they are vasodilators

inhibit voltage operated Ca2+ channles on vascular smooth muscle - leads to vasodilation and reduction in BP

21
Q

Types of calcium channel blockers and their predominant effect

A

rate-limiting: cardiac tissue (IHD) eg. verapamil

DHPs: vascular smooth muscle eg. amlodipine

22
Q

Contraindication of rate-limiting CCBs

A

heart failure

23
Q

How do diuretics treat hypertension?

A 
act on kidney
inhibit Na+/Cl- transporter in distal convoluted tubule
prevention of Na and water retention
reduction in circulating volume
(vasodilators)
24
Q

Example of diuretics used for hypertension

A

thiazide-like eg. indapamide

moderate diuretics

25
Q

Side effects of diuretics (thiazide-like agents)

A

hypokalaemia
postural hypertension
impaired glucose control - worsen diabetes
alter lipid profile (diabetogenic)

26
Q

How do alpha-blockers treat hypertension?

A

competitive receptor antagonists of α1-adrenoceptors on vascular smooth muscle
vasodilation

27
Q

Why are alpha-blockers last choice anti-hypertensives?

A

many side effects such as posturlal hypotension

28
Q

Which beta blockers are and are not preferred?

and why?

A

+ atenolol - β1 selective

- propranolol - β nonselective

29
Q

How do beta blockers treat hypertension?

A

unclear
reduction in sympathetic drive to the heart, reducing cardiac output
reduction in sympathetically evoked renin release

30
Q

What are beta blockers contraindicated with?

A

asthma

caution with COPD

31
Q

Side effects of beta blockers and why does this occur?

A

cold extremities and fatigue (find exercise more difficult)
blockade of peripheral β2-adrenoceptors opposes vasodilatation to skeletal muscle
bronchospasm - not selective

32
Q

Side effects of calcium channel blockers

A

peripheral oedema - dilate arterioles
postural hypotension
constipation

33
Q

How do you treat hypertension?

A

lifestyle - reduce CV risk: alcohol, BMI, caffeine, fat and salt, increase fruit and oily fish, exercise, smoking (doesn’t cause but makes worse)
further measurements before diagnosis

34
Q

Guidelines for treating hypertension

A

ACD
hypertension and type 2 diabetes -> ACEI/ATRA -> + CCB/diuretic
<55 and non-black -> ACEI/ATRA -> + CCB/diuretic
>55 or black -> CCB -> + ACEI/ATRA/diuretic

3rd step: take all three
4th: referral/spironolactone/alpha or beta blocker

35
Q

What should be prescribed to a p wih hypertension and IHD?

A

beta blockers

36
Q

Why does treatment differ for those <55 and non-black?

A

BP more renin dependent controlled

37
Q

How do centrally acting antihypertensives work?

and give an example and how it works

A

decrease sympathetic output from central cardiovascular control centres in the medulla
alpha-methyl dopa: false substrate leading to an anolgue of noradrenaline acting at central α2-adrenoceptors

38
Q

Benefits and disadvantages of alpha-methyl dopa

A

+ safe in pregnancy

  • widespread side effects
  • no advantages over other antihypertensive agents

Hypertensiona (8 decks)

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