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FINALS > hypertension > Flashcards

hypertension Flashcards

1
Q

what is stage 1 hypertension?

A

clinical: >= 140/90
APBM: >= 135/85

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2
Q

what is stage 2 hypertension?

A

clinical: >= 160/100
APBM: >= 150/95

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3
Q

what is stage 3/severe hypertension?

A

=> 180 systolic

=> 120 diastolic

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4
Q

what is isolated systolic hypertension?

A

systolic => 160

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5
Q

what is hypertensive crisis?

A

=> 200/120 + papilloedema

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6
Q

when should secondary disease be considered as the cause for hypertension?

A

less than 40 years old
resistant BP
positive findings on U+Es

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7
Q

when should treatment be offered?

A

for stage 2 and above

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8
Q

when should treatment be offered for stage 1?

A 
<80 years old 
has diabetes
renal disease
end organ damage
cardiovascular disease
10 years cardiovascular risk >20%
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9
Q

what is the treatment for a patient <55 years or T2DM ?

A

step 1: ACE inhibitor
step 2 : A + CCB or A + thiazide diuretic
step 3: A + B + C

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10
Q

what it the treatment for a patient =>55 years or Afro-Caribbean?

A

step 1: CCB
step 2: C + ACE inhibitor or C + thiazide diuretic
step 3: A+ B + C

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11
Q

what is step 4 for hypertension management?

A

step 4: K <= 4.5 spironolactone

K >4.5 alpha blocker or beta blocker

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12
Q

what treatment should hypertensive patients with T1DM be started on? why?

A

ACE inhibitor

due to renal protective effect

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13
Q

when can beta blockers be used first line?

A

in younger patients who:
can’t tolerate ACE
may become pregnant
have sympathetic drive signs - sweating, palpitations

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14
Q

what is a hypertensive emergency?

A

BP >200/120 with evidence of end organ failure

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15
Q

what causes a hypertensive emergency?

A 
thyroid storm 
phaeocromocytoma 
pre-eclampsia
head injury 
drugs
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16
Q

what is the management for hypertensive emergency?

A

no end organ damage: oral treatment
end organ damage (especially CCF or encephalopathy):
- labetalol if no LV failure
- furosemide + hydralazine if LV failure

17
Q

what is the aim of management in hypertensive crisis?

A

not a sudden drop in BP, slowly brought down over 24 hours

can cause stroke or dissection

18
Q

if BP is >= 180/20, when should they be admitted for specialist treatment?

A

signs of retinal haemorrhage or papilloedema

life threatening symptoms - new onset confusion, chest pain, signs of heart failure, acute kidney injury

19
Q

if BP >=180/20 but no signs of concern or life threatening symptoms, what should the next step be?

A

urgent investigation of end-organ damage

  • if found, start treatment immediately
  • if not found, repeat clinic blood pressure within 7 days
20
Q

when does ABPM take measurement?

A

least 2 measurements per hour during person’s usual waking hours (between 8-10)
use average of 14 values

21
Q

how do you record BP using home blood pressure monitoring?

A
  • 2 consecutive readings, 1 min apart with patient seated
  • twice daily, ideally morning and evening
  • at least 4 days, ideally 7
  • discard first day measurement and use average of remaining
22
Q

what is the target BP for patient <80 years?

A

clinic - 140/90

ABPM - 135/85

23
Q

what is the target BP for patient >80 years?

A

clinic - 150/90

ABPM - 145/85

24
Q

what are ACE inhibitors mechanism of action?

A

stop angiotensin I conversion to angiotensin II

25
Q

what are the common side effects of ACE inhibitors?

A

cough
hyperkalaemia
angioedema

26
Q

when must ACE inhibitors be avoided?

A

in pregnant woman

27
Q

what must be checked in a patient on an ACE inhibitor?

A

renal function must be checked 2-3 weeks after starting due to risk of worsening renal function in patients with renovascular disease

28
Q

what is the mechanism of action of CCB?

A

block voltage gated calcium channels

-relaxing vascular smooth muscle and force of myocardial contraction

29
Q

what are the common side effects of CCB?

A

flushing
ankle swelling
headache

30
Q

what is the mechanism of action of thiazide diuretics?

A

inhibit sodium absorption at the beginning of the distal convoluted tubule

31
Q

what are the side effects of thiazide diuretics?

A

hypokalaemia
hyponatraemia
dehydration

32
Q

what is the mechanism of action of angiotensin II receptor blockers?

A

block effect of angiotensin II at the AT1 receptor

33
Q

what are the side effects of angiotensin II receptor blockers?

A

hyperkalaemia

34
Q

when are angiotensin II receptor blockers most commonly used?

A

when a patient can’t tolerate an ACE inhibitor, most commonly due to cough

FINALS (25 decks)

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