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Hypertension Flashcards

(84 cards)

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1
Q

Blood pressure

A

Force per unit area exerted by blood on arterial walls

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2
Q

When does blood pressure peak

A

Mid systole - systolic bp

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3
Q

When is blood pressure lowest

A

End of diastole - diastolic bp

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4
Q

What blood pressure value shows hypertension

A

140/90

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5
Q

What physiological determinants effect blood pressure

A

Cardiac output
Systemic vascular resistance

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6
Q

What impacts cardiac output

A

Heart rate
Diastolic blood volume
Heart contractility

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7
Q

What impacts systemic vascular resistance

A

Arterial blood vessel diameter
Function of vessel smooth muscle tone
Endothelial wall stiffness

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8
Q

What conditions can hypertension lead too

A

Hypertensive heart disease
Left ventricular hypertrophy
Dilated cardiomyopathy
Myocardial infarction
Hypertensive kidney disease
Hypertensive retinopathy
Haemorrhagic stroke
Ischaemic stroke

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9
Q

How does hypertension affect afterload

A

increases - HTN increases systemic vascular resistance

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10
Q

How is the heart remodelled to overcome increased afterload in hypertension

A

Left ventricular hypertrophy to produce higher end systolic pressure

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11
Q

What is left ventricular hypertrophy

A

Left ventricular wall thickens

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12
Q

What can left ventricular hypertrophy lead to

A

Diastolic myocardial dysfunction
Systolic myocardial dysfunction
Dilated cardiomyopathy
Congestive heart failure

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13
Q

What can occur is heart muscle is not well perfused

A

Myocardial ischaemia
Myocardial infarction
Arrhythmia

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14
Q

How are blood pressure and kidney damage linked

A

Kidneys have role in bp regulation

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15
Q

Which pre-existing conditions enhance susceptibility to accelerated renal damage from hypertension

A

Renal disease
Diabetes mellitus

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16
Q

What part of the kidney is damaged by hypertension

A

Nephron glomeruli

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17
Q

How do nephrons compensate for glomurular damage from hypertension

A

Vasodilation of afferent arterioles to incr renal blood flow and glomerular filtration

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18
Q

What does vasodilation of afferent arterioles lead to

A

Incr glomerular bloodflow and and filtration
Glomerular hypertension
Glomerular hyperfiltration
Progressive glomerular sclerosis

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19
Q

How does hypertension increase CVA risk

A

Large and medium vessel Atherosclerosis
Small vessel lipohyalinosis
Cardio-emboli stroke

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20
Q

How does hypertension cause atherosclerosis

A

Stress on arteries causes vessel damage where fats can build up

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21
Q

How does hypertension cause small vessel lipohyalinosis

A

Vessel walls damaged by lipid accumulation and decreased luminal diameter, increasing risk of rupture and bleeding

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22
Q

How does hypertension cause cardioembolic stroke

A

Increased afterload and atrial dilation lead to atrial fibrillation

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23
Q

What damage can hypertension cause in retinal blood vessels

A

Arteriolar narrowing and abnormalities where arterioles and venues cross
Haemorrhages from retinal capillaries

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24
Q

What are silver/copper wire arterioles in the eyes

A

Arterioles swell due to arteriolar narrowing and the centre shines due to reflected light

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25
What are cotton wool spots in eyes
Haemorrhages from retinal capillaries
26
How many stages of hypertension are there
3
27
What bp values are stage 1 hypertension
Clinic - Systolic 140-159 and/or Diastolic 90-99 Ambulatory - systolic 135-149 and/or diastolic 85-94
28
What bp values are stage 2 hypertension
Clinic - systolic 161-180 and/or diastolic 100-119 Ambulatory - systolic 150 and/or diastolic 95
29
What bp values are stage 3 hypertension
Clinic systolic 180 and/or diastolic 120
30
What bp values show prehypertension
Systolic 120-139 Diastolic 85-89
31
What is isolated systolic hypertension
High systolic pressure, normal diastolic pressure
32
What is the most common form of hypertension in people over 65
Isolated systolic hypertension
33
What underlying conditions can cause isolated systolic hypertension
Artery stiffness Hyperthyroidism Diabetes Heart valve problems Obesity
34
Which arm should blood pressure be measured in
Both
35
When may an automated bp device not get an accurate measurement
Pulse irregularity
36
Measures to get an accurate bp reading
Patient seated for 5+ mins Correct cuff size Check pulse is regular Check more than once Check outside clinic
37
Manual bp measuring method
Inflate 20-30mmHg above loss of radial pulse Deflate 2mmHg per sec 1st sound = systolic bp 2nd sound = diastolic bp
38
Primary hypertension
No obvious direct underlying pathological cause
39
Secondary hypertension
Clear underlying cause
40
Secondary hypertension causes
Renal disease Renovascular disease Endocrine disease Coarctation of the aorta Latrogenic
41
Which enzymes are involved in the RAAS system
Renin Angiotensin converting enzyme
42
What physiological effect activates the RAAS
Decreased renal perfusion pressure
43
What are the effects of the RAAS system
System pic vasoconstriction Increased renal sodium reabsorption
44
Natriuretic peptides
Peptide hormones synthesised by the heart
45
Where is ANP synthesised
Atria
46
Where is BNP synthesised
Cardiac ventricles
47
What is released in response to atrial and ventricular dilation
Natriuretic peptides
48
What do ANP and BNP cause
Vasodilation Decreased renin Increased glomerular filtration rate
49
What hormones are released when bp increases
ANP BNP
50
What hormones are released in response to decreased BP
Local + systemic noradrenaline Systemic adrenaline
51
How do local noradrenaline, systemic noradrenaline, and systemic adrenaline increase bp
Incr heart rate Incr myocardial contractility Systemic vasoconstriction
52
What are genetic impacts on hypertension risk
Sodium channels Angiotensinogen Aldosterone ANP + BNP
53
Non modifiable risks for hypertension
Age Sex Family history Black ancestry
54
Modifiable risks for hypertension
Weight Activity Salt Stress Alcohol Smoking
55
What is the DASH diet
Low fat, low meat, 8-10 fruit/veg, whole grains, low sodium
56
What are the 3 parts of metabolic syndrome
Central obesity Hypertension Insulin resistance
57
How does diabetes contribute to hypertension
Sclerosis Increases SVR via - atheroma formation Hyperglycaemia Disordered lipid profile Vascular endothelium damage Decr NO production
58
Lifestyle modifications for hypertension patients
Potassium rich diet DASH diet Weight maintenance/loss Exercise Limit alcohol Smoking cessation
59
When should a hypertensive patient not have a potassium rich diet
Chronic kidney disease On medication that reduces potassium excretion
60
When should stage 1 hypertension be treated with drugs in under 80s
If patient has 1 or more of - Target organ damage Established CV disease Renal disease Diabetes Estimated 10 yr risk of CV disease over 10% Clinical judgement - frailty or multimorbidity
61
What additional measures should be used for patients under 40 with hypertension
Specialist evaluation of secondary causes Detailed assessment of long term treatment benefits and risks
62
What are the main classes of hypertensive drugs
ACE inhibitors Angiotensin II receptor antagonists Calcium channel blockers Diuretics Beta blockers
63
What drug class in enalapril
ACE inhibitor
64
What drug class in losartan
Angiotensin II receptor antagonist
65
What drug class is amlodipine
Calcium channel blocker
66
What drug class is indapamide
Thiazide like diuretic
67
What drug class is metoprolol
Beta blocker
68
Why should ACE inhibitors and angiotensin II receptor antagonists not be used in pregnant or breastfeeding women
Teratogenic
69
How many steps to hypertension treatment
4
70
At what stage should hypertensive drug treatment be used
Stage 2 Stage 1 w comorbidities
71
When should an ACE inhibitor or ARB be used in step 1 of HTN treatment
Type II diabetes Aged under 55 and not black African/ Afro Caribbean origin
72
When should a calcium channel blocker be used to treat stage 1 hypertension
Over 55 and no type 2 diabetes Black African/ Afro Caribbean origin and no type 2 diabetes
73
Can an ace inhibitor and ARB be combined for hypertension treatment
No
74
What is given in step 2 treatment of a hypertension patient on an ACE inhibitor or ARB
CCB or thiazide like diuretic
75
What is given in step 2 treatment of a hypertension patient on a CCB
ACE inhibitor or ARB or thiazide like diuretic
76
What is given in step 3 hypertensive treatment
ACE inhibitor or ARB CCB Thiazide like diuretic
77
What is hypertension regarded as if not controlled by step 3 treatment
Resistant hypertension
78
How is resistant hypertension treated (step 4 treatment)
Fourth hypertensive drug or specialist advice
79
How should resistant hypertension be confirmed before starting step 4 treatment
Confirm bp with ambulatory or home measurements
80
What should be done if bp is not decreasing with treatment
Discuss medication adherence w patient Discuss how meds are being taken w patient Consider secondary causes
81
What is evidence of end organ damage
Papilloedema Retinal haemorrhage Mental status changes Chest pain Dyspnoea Acute heart failure Acute kidney injury
82
What is a hypertensive emergency
BP 180/120 + Evidence of end organ damage
83
How are hypertensive emergencies treated
Immediate specialist referral and/or hospital admission
84
Why should BP 180-120+ with no evidence of end organ damage not be treated until repeat measurement taken
No evidence for benefit in rapid reduction Aggressive therapy may cause cardiac, renal, or cerebral hypoperfusion

CR2 (33 decks)

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