Hypertension

Question 1

what is hypertension

Answer 1

blood pressure that is too high

Question 2

what does blood pressure include

Answer 2

systolic and diastolic pressures

Question 3

what is BP measured in

Answer 3

mmHg

Question 4

BP measurement

Answer 4

clinic/surgery
24hr ambulatory
home/self
all - relax for 5mins - at least 3 readings - first assessment both arms
at least 3 readings over several weeks - should be away from clinical setting

Question 5

CVD and risk factors - mainly refers to diseases affecting:

Answer 5

coronary heart disease
cerebrovascular diseases
other arterial diseases

Question 6

coronary heart disease - risks for what diseases

Answer 6

MI
angina
sudden cardiac death
heart failure

Question 7

cerebrovascular diseases - risks for what diseases

Answer 7

cerebrovascular attack - cva, stroke
transient ischaemic attack (TIA)
multi-infarct dementia

Question 8

other arterial diseases - risks for what diseases

Answer 8

peripheral vascular disease
renal impairment, renal artery stenosis
abdominal aortic aneurysm (AAA)
retinopathy, papilledema

Question 9

risk factors for atherosclerosis and CVD

Answer 9

hypertension
hyperglycaemia
kidney disease
dyslipidaemia
insulin resistance
obesity
poor fitness
family history of CVD
lifestyle risk factors - smoking, poor diet, poor sleep

Question 10

CVD risk factors

Answer 10

age
elevated BP
elevated cholesterol
increased BMI
impaired glucose tolerance
decreased renal function

Question 11

what does diagnosis of hypertension require

Answer 11

both conventional BP > 140/90
and ABPM/home BP >135/85

Question 12

signs of hypertensive tissue damage

Answer 12

kidneys - urinalysis for proteinuria
heart - ecg, left ventricular hypertrophy
retina - fundoscopy, hypertensive retinopathy

Question 13

treating hypertension

Answer 13

target people with highest sustained BP - grade 2 HT and/or TOD
and highest absolute risk - best to prioritise treatment in high risk groups
includes those with existing CVD, diabetes, chronic kidney disease, 10yr CVD risk

Question 14

ACE inhibitors

Answer 14

inhibit angiotensin converting enzyme, block RAAS, increase bradykinin (vasodilator), dilate arteries and veins

Question 15

ACE inhibitor side effects

Answer 15

cough, rise in or high K+, renal dysfunction

Question 16

examples of ACE inhibitors

Answer 16

enalapril
lisinopril
ramipril

Question 17

angiotensin 2 receptor blockers

Answer 17

similar to ACE inhibitors, no BK effect

Question 18

angiotensin 2 receptor blocker side effects

Answer 18

few
rise in/high K+, renal dysfunction

Question 19

angiotensin 2 receptor blocker examples

Answer 19

losartan
candesartan

Question 20

calcium channel blockers

Answer 20

block voltage gated calcium channels, dilate arteries, sometimes heart rate reduction

Question 21

calcium channel blocker side effects

Answer 21

headaches, flushing, ankle swelling, tachycardia

Question 22

side effects of rate limiting calcium channel blockers

Answer 22

bradycardia, constipation, other GI symptoms

Question 23

examples of calcium channel blockers

Answer 23

nifedipine
amlodipine
rate limiting - verapamil, diltiazem

Question 24

diuretics

Answer 24

inhibit Na Cl symport, distal tubular natriuresis, dilate arteries and veins

Question 25

side effects of diuretics

Answer 25

impotence, rashes, biochemical - low Na+, low K+ raised glucose (risk of diabetes), high urate (risk of gout)

Question 26

examples of diuretics

Answer 26

bendroflumethiazide chlortalidone indapamide

Question 27

beta blockers

Answer 27

block β-adrenoceptors, reduce cardiac rate and output, block RAAS, initially vasoconstrict, ultimately vasodilate

Question 28

side effects of beta blockers

Answer 28

wheeze (caution with asthma/copd), cold peripheries, lassitude, exercise intolerance, impotence, bradycardia, heart block, raised glucose

Question 29

examples of beta blockers

Answer 29

atenolol metoprolol bisoprolol

Question 30

mineral corticoid blockers

Answer 30

block mineral corticoid receptors, distal nephron natriuresis/limit potassium loss potassium sparing diuretics

Question 31

side effects of MC blockers

Answer 31

rise in/high K+, gynaecomastia (with spironolactone)

Question 32

examples of MC blockers

Answer 32

spironolactone eplerenone

Question 33

alpha blockers

Answer 33

block ⍺1-adrenoceptors, dilate arteries and veins

Question 34

side effects of alpha blockers

Answer 34

dizziness, especially on standing urinary symptoms tachycardia oedema

Question 35

examples of alpha blockers

Answer 35

doxazosin

Question 36

reasons for treatment failure

Answer 36

poor adherence ineffective combinations other drugs e.g. NSAIDs inappropriately low doses secondary causes

Question 37

primary and secondary cause percentage

Answer 37

~95% primary ~5% secondary

Question 38

environmental causes of hypertension

Answer 38

body weight - obesity physical inactivity excess calorie intake salt - high sodium, low potassium, low magnesium excess alcohol stress diet rich in grains, veg, low saturated fat

Question 39

genetic causes of hypertension

Answer 39

30-50% genetic heritability twins association genome wide linkage genome wide association studies not finding genes of major effect