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Flashcards in HPN Deck (70):
1

Deaths in hypertensive patients have been shown
to be due to
1
2
3
4

stroke 45%, heart failure 35%,
kidney failure 3% and others 17%.

2

Factors increasing chances of dying in hypertensive
patients are:
1
2
3
4

male patient, young patient, family
history, increasing diastolic pressur

3

For adults aged 18 years
and older hypertension is:

• diastolic pressure >90 mmHg and/or
• systolic pressure >140 mmHg

4

•__________ is that of
≥ 140 mmHg in the presence of a diastolic
pressure <90 mmHg

Isolated systolic hypertension

5

__________ is the presence of
sustained hypertension in the absence of
underlying, potentially correctable kidney,
adrenal or other factors

Essential hypertension

6

____________is that with a diastolic
pressure >120 mmHg and exudative vasculopathy
in the retinal and kidney circulations

Malignant hypertension

7

_________ is a BP >140/90 mmHg
despite maximum dosage of tw o drugs for 3–4
months

Refractory hypertension

8

90% of HPN are ________

essential

9

What kind of HPN?

It is also more likely in patients
whose BP is responding poorly to drug therapy,
patients with well-controlled hypertension whose BP
begins to increase, and patients with accelerated or
malignant hypertension

Secondary hypertension

10

PE for secondary HPN

Abdominal systolic bruit

Kidney artery stenosis

11

PE for secondary HPN

Proteinuria, haematuria, casts

Glomerulonephritis

12

PE for secondary HPN

Bilateral kidney masses with or without haematuria

Polycystic disease

13

PE for secondary HPN

History of claudication and delayed femoral pulse

Coarctation of the aorta

14

PE for secondary HPN

Progressive nocturia, weakness

Primary aldosteronism (check serum potassium)

15

PE for secondary HPN

Paroxysmal hypertension with headache, pallor,
sweating, palpitations

Phaeochromocytoma

16

Renal Artery Stenosis

_______ kidney artery stenosis accounts for
the majority of cases, while ______
remains an important cause

Atherosclerotic


fibromuscular dysplasia

17

How record HPN?

On each occasion when the BP is taken, two or more
readings should be averaged. Wait at least 30 seconds
before repeating the procedure.

18

When to repeat BP readings?

If the first two readings differ by more than 6 mmHg systolic or 4 mmHg diastolic, more readings should be taken

19

Whom to measure sitting and standing BP?

Measure sitting and standing BP in elderly
and diabetic patients

20

If the initial reading is high (DBP >90 mmHg, SBP
>140 mmHg) repeat the measures after______

10 minutes of quiet rest.

21

The________ influence in the medical
practitioner’s office may cause higher readings so
measurement in other settings such as the home or
the workplace should be managed whenever possible.

‘white coat’

22

Initial diastolic BP readings of 115 mmHg or more,
particularly for patients with __________
may need immediate drug therapy

target organ damage,

23

If mild hypertension is found, observation with
repeated measurement over________months should be
followed before beginning therapy

3–6

24

This is required for the diagnosis and follow-up
of patients with fluctuating levels, borderline
hypertension or refractory hypertension (especially
where the ‘white coat’ effect may be significant

Ambulatory 24-hour monitoring

25

Guidelines for ambulatory BP measurement:
1
2
3
4
5

• unusual variability of office BP
• marked discrepancy between office and house BP
• resistance to drug treatment
• suspected sleep apnoea
• when two BP readings >140/90

26

These people have a
type of conditioned response to the clinic or office
setting and their home BP and ambulatory BP
profiles are normal.

‘White coat’ hypertension

27

T or F

Pts with ‘White coat’ hypertension

They appear to be at low risk of cardiovascular disease but may progress to sustained
hypertension

T

28

If the average diastolic BP at the initial visit is
90–100 mmHg, and there is no evidence of end organ
damage, _____ is indicated

non-pharmacological therapy is indicated for a
3-month period

29

Hovell has estimated that for every
1 kg of weight lost, BP dropped________

by 2.5 mmHg
systolic and 1.5 mmHg diastolic

30

Drinking more than _______of alcohol a day
raises BP and makes treatment of established
hypertension more difficult.

20 g

31

Reduction or withdrawal of regular alcohol intake
reduces BP by ______

5–10 mmHg

32

Reduction of sodium intake to less than ______
sodium per day is advised

100 mmol

33

_____ and_______ exercise helps to
reduce BP

Regular aerobic or isotonic

34

There is evidence that _______ and _______ supplementation can reduce BP

lacto–vegetarian diets and
magnesium

35

HPN Tx

A period of _______weeks is needed for the effect to
become fully apparent

4–6

36

Relatively ineffective combinations of anit HPN

• Diuretic and calcium-channel blocker
• β -blockers and ACE inhibitors

37

Undesirable combinations
• More than one drug from a particular
pharmacological group:
— ___________(heart block, heart
failure)
— __________ (hyperkalaemia)

β -blockers and verapamil

potassium-sparing diuretics and ACE
inhibitors or ARB

38

_________ are good first-line therapy for
hypertension

Thiazides

39

___________ are less potent as antihypertensive
agents but are indicated where there is
concomitant cardiac or kidney failure and in
resistant hypertension

Loop diuretics

40

________ are less effective where there is kidney
impairment

Thiazides

41

_______ may antagonise the antihypertensive
and natriuretic effectiveness of diuretics

NSAIDs

42

A diet high in potassium and magnesium should
accompany _______ therapy (e.g. lentils, nuts,
high fibre

diuretic

43

_______ has different properties to the thiazide
and loop diuretics and has less effect on serum lipids

Indapamide

44

NSAIDs may interfere with the hypotensive
effect of ________

β -blockers.

45

___________plus a β -blocker may unmask
conduction abnormalities causing heart block

Verapamil

46

• These drugs reduce BP by vasodilatation.
• The properties of individual drugs vary,
especially their effects on cardiac function

CCB

47

The ________ compounds (nifedipine and
felodipine) tend to produce more vasodilatation
and thus related side effects

dihydropyridine

48

Unlike verapamil or diltiazem (which slow the
heart), ___________ drugs can be used safely
with a β -blocker

dihydropyridine

49

_________ is contraindicated in second and third
degree heart block

Verapamil

50

______ and _______ should be used with
caution in patients with heart failure

Verapamil and diltiazem

51

Angiotensin-converting enzyme is responsible for

1
2
3

1. converting angiotensin I to angiotensin II (a potent
vasoconstrictor and
2. stimulator of aldosterone
secretion) and
3. for the breakdown of bradykinin
(a vasodilator).

52

Cough, which occurs in about _______of patients, may disappear with time or a reduction in dose but it often persists and requires a change in drug in some patients.

15%

53

_______ a potentially life-threatening condition,
may occur in 0.1–0.2% of subjects.

Angioedema,

54

These agents competitively block the binding of
angiotensin II to type I angiotensin receptors and
block the effects of angiotensin more selectively
than the ACE inhibitors

Angiotensin II receptor
antagonists (sartans

55

They
are useful alternatives for hypertensive patients who
discontinue an ACE inhibitor because of cough and
may be used in combination with thiazide diuretics.

Angiotensin II receptor
antagonists (sartans

56

A specific problem of this alpha blocker is the ‘firstdose
phenomenon’; this involves acute syncope about
90 minutes after the first dose, hence treatment
is best initiated at bedtime

Prazosin

57

Prazosin potentiates_______ and works best if used with them

β -blockers

58

Other than calcium-channel blockers these include
hydralazine, minoxidil and diazoxide, which are
not used for first-line therapy but for refractory
hypertensive states and hypertensive emergencies

Vascular smooth muscle relaxants

59

example of such a central acting agent is______
which apparently stimulates the imidazoline
receptors in the brain to inhibit sympathetic outflow
in the body

moxonidine,

60

Typical
presentations of hypertensive emergencies (which
are rare) include

hypertensive encephalopathy, acute
stroke, heart failure, dissecting aortic aneurysm and
eclampsia.

61

BP goals in HPN Emergencies

Aim to reduce the
BP by no more than 25% within the first 2 hours then
towards 160/100 mmHg within 2 to 6 hours.

62

Isolated systolic hypertension is most frequently seen
in __________

elderly people

63

T or F

Patients with isolated systolic hypertension
should be treated in the same way as those with
classic systolic/diastolic hypertension

64

________exists where control has not
been achieved despite reasonable treatment for 3–4
months

Refractory hypertension

65

_____ and_____ are preferable in the young hypertensive, with______ a second agent.

ACE inhibitors or calcium-channel blocking agents

diuretics

66

Older patients may respond to ______

nonpharmacological
treatment.

67

Reducing dietary sodium is more beneficial than
with _______

younger patients.

68

Add only one agent at a time and wait about_______
weeks between dosage adjustments

4

69

Older patients may respond better to
1
2
3

diuretics,
calcium-channel blockers and ACE inhibitors.

70

Younger patients may respond better to
1
2

β -blockers
or ACE inhibitors