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Hypertension Flashcards

(49 cards)

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1
Q

What is hypertension?

A

Is that blood pressure at which benefits of treatments with antihypertensive agents in reducing cardiovascular, cerebrovascular and peripheral vascular risk outweighs the risk of treatment

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2
Q

When does a person have hypertension?

A

140/90

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3
Q

What happens when there is a 2 mmHg rise in BP?

A

7% increase risk of mortality in IHD
10% increase mortality from stroke

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4
Q

What does an increase in BP of 20mmHg systolic and 10mmHg diastolic?

A

Doubles risk of CVD death regardless of age

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5
Q

What is hypertension a risk factor for?

A

MI, Heart failure, stroke, cardiovascular disease

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6
Q

What organ does hypertension affect?

A

Damages every organ
End-organ damage

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7
Q

What can make BP fluctuate during the day?

A

Physical and mental stress

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8
Q

What is stage 1 hypertension?

A

140/90 mmHg
ABPM daytime average of 135/85 mmHg or more

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9
Q

What is stage 2 hypertension?

A

160/100 mmHg
ABPM daytime average of 150/120 mmHg or higher

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10
Q

What is stage 3 or severe hypertension?

A

180/120 mmHg or higher

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11
Q

What is ABPM measurements?

A

30 measurements over the day or so
More accurate reflection of BP

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12
Q

What is primary hypertension?

A

No cause is identified - 80-90% of cases

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13
Q

What is secondary hypertension?

A

Can have chronic renal disease, renal artery stenosis or endocrine disease
More common in younger patients

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14
Q

What is the risk factors for hypertension?

A

Cigarette smoking, Diabetes, Renal disease, Male (2x), hyperlipidaemia, previous stroke and LV hypertrophy (2x)
Low fitness is main factor

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15
Q

What are the primary contributors to BP?

A

Cardiac output - CO=SV x HR
Peripheral vascular resistance

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16
Q

What does sympathetic system activation produce?

A

Vasoconstriction
Reflex tachycardia
Increased stroke volume

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17
Q

What does renin stimulation produce?

A

Produces angiotensin II and aldosterone
Angiotensin II - vasoconstrictor
Aldosterone - salt and water retention which increases the circulating blood volume

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18
Q

What is the RAAS responsible for?

A

Maintenance of sodium balance
Control of blood volume
Control of blood pressure

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19
Q

What is RAAS stimulated by?

A

Fall in BP
Fall in circulating volume
Sodium depletion
These stimulate release of renin from the juxtaglomerular apparatus

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20
Q

Explain the aetiology of hypertension?

Study These Flashcards
A

Polygenic - major genes and poly genes
Polyfactorial - environment, individual and shared

21
Q

What is the likely causes of hypertension?

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A

Increased reactivity of resistance vessels and resultant increase in peripheral resistance
Sodium homeostatic effect - kidneys unable to secrete appropriate amounts of Na for any given BP. Fluid is then retained so BP increases

22
Q

What are other factors that can cause hypertension?

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A

Age, genetics and FH, environment, weight, alcohol intake and race

23
Q

Explain hypertension and age

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A

BP tends to rise with age due to decreased arterial compliance
Treatment will reduce stroke and MI risk
Pragmatic approach as elderly more susceptible to adverse effects

24
Q

Explain hypertension and genetics

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A

Hypertension can run in families
Closest correlation is between siblings
Environmental factors have a role in the development

25
Explain environment and hypertension
Mental and physical stress increase BP True stress - tend to be highly resistant to treatment White coat hypertensives are at risk of CVD
26
Explain alcohol and hypertension
Common causes in young men Large amounts of alcohol increase BP If reduce alcohol intake then BP will fall
27
Explain weight and hypertension?
Obese patients have increased BP Weight loss can produce a fall in BP Most important non- pharmacological measure
28
Explain birth weight and hypertension
Low birth weight is associated with higher likelihood of developing hypertension and heart disease in adulthood Each Kg lost, 1-2mmHg higher
29
Explain race and hypertension?
Caucasians have lower BP then African populations in same environment Reasons are unclear African populations seen as salt retainers so more sensitive
30
What are the steps in treatment for hypertension?
Confirm diagnosis Assess risk factors - calculator/ Q risk Assess end organ damage
31
How do you assess end organ damage?
ECG, Echocardiogram, proteinuria, renal ultrasound, renal function
32
What are some treatable causes for hypertension?
Obesity, renal artery stenosis, endocrine causes, coarctation of aorta, drug induced and sleep apnoea
33
Explain treatment for stage 1 hypertension?
Antihypertensive - if under 80 with one of: target end organ damage, renal disease, CVD, Diabetes Under 40s - look for causes Elderly - offer antihypertensive taking into account of co-morbidities
34
What is the treatment for stage 2 hypertension?
Antihypertensive to people of any age
35
What is step 1 of choosing antihypertensive?
Aged over 55 or black people f African/Caribbean descent - calcium channels blocker or thiazide like diuretic Under 55 - ACE inhibitor or ARB. Careful with women of child bearing age
36
What is step 2 and 3 of choosing antihypertensive drug treatment?
2 - add thiazide type diuretic to step 1 (Indapamide) 3 - Add CCB, ACEi and diuretic together
37
What is step 4 for choosing an antihypertensive drug treatment?
Resistant hypertension Unable to achieve target BP despite 3 or more agents Consider compliance issues, high dose thiazide, or further diuretic therapy (spironolactone)
38
What are some antihypertensive drugs?
Angiotensin converting enzyme inhibitors Competitively inhibit the action of ACE - ACE converts angiotensin I to II which is a vasoconstrictor
39
What are some contradictions to ACEi?
Renal artery stenosis Impaired renal function Hyperkalaemia Fertile female
40
What are some drug-drug interactions that can occur?
NSAIDs - precipitate acute renal failure Potassium supplements/ potassium sparing diuretics - hyperkalaemia
41
Explain angiotensin II receptor blockers
ARB ex. losartan, valsartan, candesartan Inhibit action of angiotensin II at AT1 receptor Advantage of ACEi - fewer side effects
42
Describe some calcium channels blockers
Vasodilators - reduce peripheral vascular resistance. >55 and women of child bearing age Rate limiting Ca2+ blockers - reduce HR and produce some vasodilation Both block the L type Ca2+ channels in myocytes
43
What are some adverse drug reactions to calcium channel blockers?
Flushing, headaches, ankle oedema, indigestion Can be rate limiting as can also cause bradycardia and constipation
44
What are some contraindications for CCB?
Acute MI Heart failure Bradycardia
45
Describe thiazide type diuretics
Ex. Indapamide First line therapy usually in people of African/ Caribbean origin Can be used in combination with antihypertensive Benefit in reducing risk of stroke and MI Low doses so don't cause significant diuresis
46
What is thiazide type diuretics mechanism of action?
Enhances urinary excretion of sodium Resistance vessel dilation - reduced resistance Effect may take weeks Side effects include gout and ED
47
What are some less commonly used agents?
Alpha adrenoreceptor antagonist - Doxazosin which opposes smooth muscle contraction Centrally acting agents - methylopa and moxonidine which can be used in pregnancy Vasodilators - hydralazine and minoxidil
48
Explain common treatment regime for age >55 or African/ Caribbean origin
Start CCB Add thiazide diuretic Add ACEi or ACE Add beta blocker or alpha blocker Add less commonly used agent
49
Explain a common treatment regime for an under 55?
Start ACEi Add thiazide diuretic Add CCB Add beta blocker Add less commonly used agent

Cardiovascular (33 decks)

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