hypertension 1&2

Question 1

define hypertension

Answer 1

sustained or persistent elevated arterial BP

Question 2

what effects hypertension?

Answer 2

age, gender, race

Question 3

is hypertension bimodal?

Answer 3

no, it is normal among BP population

Question 4

what is normotensive and hypertensive?

Answer 4

normotensive- normal blood pressure

hypertensive- high blood pressure

Question 5

what is the 2 things hypertension is based on?

Answer 5

associated CV risk

based on arbitrarily defined ‘normal’ BP levels

Question 6

what does NICE define as hypertensive?

Answer 6

140/90mmHg

Question 7

what does ACC/AHA define as hypertensive?

Answer 7

130/80 mmHg

Question 8

what ways does misdiagnosis usually occur?

Answer 8

Poor sensitivity & specificity

‘White coat’ hypertension phenomenon

Question 9

what do NICE recommend in order to avoid misdiagnosis?

Answer 9

Multiple clinic/office BP measurements >140/90 mmHg

Ambulatory BP monitoring (ABPM) orHome BP monitoring (HBPM) >135/85 mmHg

Question 10

how is hypertension classified?

Answer 10

according to blood pressure level( moderate to severe)
traditional 1-3
nice stages 1-3

Question 11

when does CVD risk double?

Answer 11

doubles with each BP increment of 20/10 mm Hg

Question 12

what does target organ damage effect?

Answer 12

Cerebrovascular disease
Hypertensive retinopathy
Left ventricular dysfunction
Coronary artery disease
Peripheral artery disease
chronic kidney disease

Question 13

how is hypertension categorized based on the aetiology?

Answer 13

hypertension w/ known causes (secondary 5-10%)

hypertension w/ unknown causes(primary 90-95%)

Question 14

what are the 4 secondary causes of hypertension?

Answer 14

renal/endocrine/pregnancy/ drugs

Question 15

what does primary hypertension cause?

Answer 15

increase in total peripheral resistance

Hyper-reactivity of BP to stress, abnormal vascular reactivity & impaired circulatory homeostasis

Question 16

is hypertension a disorder?

Answer 16

yes its a disorder or a syndrome

Question 17

what are the 3 things that control BP?

Answer 17

cardiac output
peripheral resistance
blood volume

Question 18

what are 4 sites of blood pressure control?

Answer 18

1-resistance arterioles
2-capacitance venules
3-pump output heart
4-vol in kidneys

Question 19

what are the major postulates of pathogenesis mechanisms?

Answer 19

role of:genetics/ kidney/vascular reactivity and remodelling/neurohormonal factors/central and sympathetic NS

Question 20

what kind of risks are there?

Answer 20

modifiable- e.g. diet

non- modifiable- e.g. genetics

Question 21

why do you treat hypertension?

Answer 21

to target organ damage
associated with CV mortality
lowering BP reduces CV mortality

Question 22

for treatment, what is the goal for maintaining BP?

Answer 22

> 140/90 mmHg (office/clinic)or>135/85 mmHg (ABPM/HBPM)for all adults under 80 years old
150/90 mmHg (office/clinic)or>145/85 mmHg (ABPM/HBPM)for adults 80 years old and over

Question 23

what are the 6 pharmacological treatments for hypertension?

Answer 23

ACE Inhibitors (ACEIs)
Angiotensin II receptor antagonists (ARBs)
Calcium channel antagonists
Diuretics
b-Adrenoceptor antagonists (b-blockers)
Miscellaneous

Question 24

what are the aims of non-pharmacological therapy?

Answer 24

to help lower BP
to control other risk factors
to help reduce doses of other hypertensive drugs

Question 25

what are the 5 steps of modification of lifestyle?

Answer 25

``` 1- weight reduction 2- dash eating plan 3- dietary na+ reduction 4-physical activity 5-alcohol moderation ```

Question 26

what are the main mechanisms for lowering BP?

Answer 26

decrease plasma volume decrease total peripheral resistance (TPR) decrease cardiac output (CO) or combinations of three mechanisms

Question 27

what is ACEIs mechanism of antihypertensive effect?

Answer 27

dec angiotensin II production dec vasoconstriction  dec PVR  dec aldosterone secretion  dec fluid retention  dec PV  dec sympathetic activation  dec vasoconstriction  dec PVR these in turn inc bradykinin and PGI2 synthesis

Question 28

what is ACEIs first choice initial therapy for?

Answer 28

younger hypertensive patients (55 years old) of non-African or Caribbean descent All diabetic patients, irrespective of age or ethnic origin

Question 29

what is the mechanism for ARBs?

Answer 29

reduction of BP via AT1-receptor blockade dec vascular AT1-R activation  dec vasoconstriction  dec PVR dec aldosterone secretion  dec fluid retention dec in PV decsympathetic activation  dec vasoconstriction  dec PVR

Question 30

initial use of ARBs when:

Answer 30

younger hypertensive patients (55 years old) of non-African or Caribbean descent All diabetic patients, irrespective of age or ethnic origin

Question 31

what is ARBs effective in combination with?

Answer 31

effective combination with CCBs & thiazide-type diuretics

Question 32

how do CCBs produce their antihypertensive effect?

Answer 32

reduction of BP viablock of Ca++influx into heart cells and/or blood vessels

Question 33

CCBs are first line when:

Answer 33

elderly hypertensive patients (aged 55 and over)black (African/Caribbean) patients of any age

Question 34

what are CCBs effective in combination with?

Answer 34

CEIs, ARBs, BBs & thiazide-type diuretics

Question 35

how do diuretics produce their antihypertensive effect?

Answer 35

reduction of BP via: - increased diuresis-reduced plasma volume and decrease in CO - reduced peripheral vascular resistance(vasodilation/ NA stores)

Question 36

how much can diuretics lower BP by?

Answer 36

10-15mmHg

Question 37

what are the main dose of diuretics given?

Answer 37

low dose thiazide & thiazide-like agents used

Question 38

diuretics recommended for an ALTERNATIVE first choice when

Answer 38

elderly hypertensive patients (aged 55 and over) | black (African/Caribbean) patients of any age

Question 39

diuretics effective when given with:

Answer 39

AEIs, ARBs & CCBs

Question 40

what is the mechanism for antihypertensive effect for B-adrenoceptor antagonists?

Answer 40

``` unsure... postulate mechanisms: reduction of CO inhibition of renin release modulation of central BP regulation resetting of baroreceptors readjustments of blood flow ```

Question 41

what are the initial effects of b-adrenoceptor antagonists?

Answer 41

decrease in BP due to decrease in CO | PRV may increase slightly

Question 42

what are the chronic effects of antihypertensive action?

Answer 42

CO may or may not return to normal sustained reduction in PVR  decrease BP

Question 43

how much can b-adrenoceptors reduce BP by?

Answer 43

15-20%

Question 44

when are b-adrenoceptors an effective therapy?

Answer 44

combination with DH-type CCBs