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

aetiology, pathology and treatment of hypertension Flashcards

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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?

Study These Flashcards
A

vasoconstrictor

anti- natriuretic peptide

stimulator of aldosterone release from the adrenal glands

21
Q

whats the aetiology of hypertension?

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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?

Study These Flashcards
A

not necessarily

23
Q

causes for secondary hypertension?

Study These Flashcards
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?

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

Assess end organ damage

Screen for treatable causes

25
why do we treat hypertension?
reduce cerebrovascular disease by 40-50% | reduce MI by 16-30%
26
how do you treat stage 1 hypertension?
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
how do you treat stage 2 hypertension?
ABPM> 150/95 | Offer antihypertensive drug treatment to people of any age with stage 2 hypertension.
28
whats the first step for choosing antihypertensive druug treatment?
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
whats the second step for treatment for hypertension?
Add Thiazide-type diuretic such as clortalidone or indapamide to CCB or ACEI/ARB
30
step 3 for treatment of hypertension?
Add CCB, ACEI, Diuretic together
31
treatement of resistant hypertension
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
what inhibits the actions of angiotensin converting enzyme?
RAMIPRIL
33
what is the function of angiotensin converting enzyme?
converts angiotensin I to active angiotensin II which is a potent vasoconstrictor and hypertetrophogenic agent
34
what plays a significant role in organ damage?
angiotensin II
35
what are the contraindications of angiotensin II?
Renal artery stenosis Renal failure Hyperkalaemia
36
what are the adverse reactions of angiotensin
``` cough first dose hypotension taste disturbance renal impairment angioneurotic oedema ```
37
what is the function of calcium channel blockers?
vasodilator and rate limiting
38
CCB work by...
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
who should you give CCBs to?
``` over 55years. women of child baring age Compliance is high, Benefit in the elderly patient with systolic Hypertension Rarely cause postural hypotension ```
40
what are contraindications of CCBs
Acute MI | Heart failure, bradycardia (rate limiting CCBs)
41
what are adverse drug reactions of CCBs
Flushing Headache Ankle oedema Indigestion and reflux oesophagitis
42
what drug should you gibe to afro-caribbean?
thiazide | Indapamide, Clortalidone
43
whats the function of doxazosin?
Selectively block post synaptic 1-adrenoceptors | Oppose vascular smooth muscle contraction in arteries
44
what are the adverse reactions of doxazosin?
First dose hypotension Dizziness Dry mouth Headache
45
what drug should you use for pregnant people?
METHYLDOPA
46
what are adverse reactions of methyldopa?
Sedation and drowsiness Dry mouth and nasal congestion Orthostatic hypotension
47
what is the treatment regime for hypertension if over 55 years?
``` 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
what is the treatment regime for hypertension if young?
``` 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
what is the second most comon cause of maternal and fetal death?
hypertension

1st year systems (74 decks)

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