CVD - Hypertension Flashcards Preview

► Med Misc 43 > CVD - Hypertension > Flashcards

Flashcards in CVD - Hypertension Deck (15):
1

(5) What does hypertension predispose to?

•coronary heart disease
•stroke
•cardiac hypertrophy
•heart failure
•kidney failure

2

Compare prevalence of primary & secondary hypertension

Primary hypertension:
•In 95% of hypertension, no specific cause is identified.

Secondary
•In 5% of hypertension a specific cause is identified.

3

(4) Causes of secondary hypertension

•renal disease
•renal artery stenosis
•adrenal tumors secreting
–aldosterone
–cortisol
–catecholamines
•sleep apnea

4

Causes of primary hypertension
- (3) genetic
- (3) environmental

•polygenic
–sympathetic hyperactivity
–renin activation
–susceptibility to salt

•multi-environmental
–obesity
–excess salt (especially in elderly)
–alcohol

5

How do you diagnose hypertension?

•BP > 140/90 mmHg
•after 5 minutes seated rest
•2 readings 2 minutes apart

6

(5) routine tests in hypertensive patients

•FBE
–associated anemia of CKD
•LFTs
–associated fatty liver or drug reaction
•urine albumin/creatinine ratio
–evidence of renal damage
•MSU
–clues as to causes of renal disease
•ECG and echocardiogram
–to detect coronary disease and cardiac hypertrophy

7

When do you treat hypertension?

•SBP > 180 mmHg
•DBP > 110 mmHg
•SBP > 160 mmHg & DBP 140 mmHg or DBP > 90 mmHg WITH associated conditions (diabetes, existing CV or renal disease) OR high CV risk

8

High CV risk
- risk of CV event over 5 years
- by (5) standard risk factors
- by (4) end organ damage

> 15%

Standard RF:
•Age
•Systolic pressure
•Total:HDL cholesterol ratio
•Smoking
•Diabetes

End organ damage as a RF:
•Microalbuminuria or low eGFR
–renal damage
•LV Hypertrophy
–cardiac damage
•High pulse wave velocity
–stiff large arteries
•Increased intima-media thickness
–reflects atherosclerosis

9

(5) Non-pharm treatment of hypertension

•Lose weight
•Improve fitness
•Avoid excess salt
•Moderate alcohol
•Stop smoking

10

Which is more important in pharmacological blood pressure reduction: how or how much?

How much

11

(4) drug treatments of hypertension (antihypertensives)

ABCD

ACE inhibitors, ARBs
Beta-blockers
Ca antagonists
Diuretics

NOTE:
•Most patients require more than 1 drug
•Wait 2-3 weeks before adding drugs
•Combination drugs are simpler

12

Describe the antihypertensives drug treatment algorithm
- step 1
- step 2
- step 3
- step 4

Step 1:
- Monotherapy; A, C or D

Step 2:
- Dual therapy: A+C or A+D

Step 3:
- Triple therapy: A+C+D

Step 4: "resistant hypertension"
•consider adding spironolactone, beta-blocker, centrally-acting agent, alpha-blocker or vasodilator
•question compliance
•check for use of NSAIDs, cold remedies, antidepressants, etc
•consider secondary causes

13

What are the general considerations for the use of ABCD antihypertensives?

ACEI/ARBs:
- Useful in coronary disease and heart failure
- Renoprotective in diabetes
- Contra-indicated in pregnancy

Beta blockers:
- Useful in coronary disease and heart failure

Ca2+ blockers:
- Avoid verapamil & diltiazam in heart failure

Diuretics:
- Thiazide-like drugs have less metabolic side-effects

14

What is the most important cause of “resistant hypertension”?

Poor compliance

15

Why are beta blockers not favoured as step 1 antihypertensive?

Due to SE of increased weight and insulin resistance

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