Hypertension Flashcards by mohamed nascer

what is the definition of hypertension ?

Systolic bp above 140

diastolic bp above 90

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what are the types of hypertension?

primary hypertension

2ndary hypertension

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what is primary hypertension ?

unknown cause but mostly GENETICS

environmental factors affecting CV and renal structure function

associated with certain risk factors

Rarely in young

TREATED BY TREATING HTP ITSELF AND ITS FACTORS

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what is secondary hypertension 5-10%

Has a cause —>DRUG, DISEASE ( adrenal tumor, excessive corticosteroid ) , PREGNANCY

occurs in all ages including YOUNG

Treat the cause causing HTN

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what are the risk factors for primary hypertension?

Smoking
unhealthy diet
excess salt and water retention
stress
physical inactivity
obesity
males
alcohol
black
aged
genetics

these are js risk factors not causes

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what are IMPORTANT CAUSES of secondary hypertension ?

Conns Syndrome —> Excessive aldosterone due to adenoma

Cushing syndrome —> excessive cortisol

Pheochromocytoma —> rare tumor causes excessive release of catecholamines

Renal disease —> renovascular disease , renoparenchymal disease

Obstructive sleep apnea

Hyper parathyroidism —> high calcium –> HTN

Hypothyroidism and hyperthyroidism

Oral contraceptive pills —> Steroids –> salt and water retention

Chronic use of NSAIDS –> salt + water retention

Antipsychotic/ anti depressants drugs —> increase BP

Erythropoietin —> increased RBCS and viscosity –> more force –> HTN

Cytoxic drugs —> endothelial damage

Cocaine —> episodic HTN

vasoconstrictor drugs

sodium containing antacids

Liquorice —> Increase aldosterone release

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what is the organ responsible for managing BP?

kidneys

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what are the 3 major causes of 2dry hypertension ?

Primary aldosteronosim ( PA )

Renal disease

Obstructive sleep apnea

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describe primary aldosteronism ?

high BP , High PH , low K

hypokalemia , metabolic alkalosis due to high PH greater than 7.45

Elevated aldosterone / renin ration —> this means aldosterone is secreted without stimulus from renin

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what are the renal disease ?

renovascular hypertension

reno parenchymal hypertension

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what are the causes of renovascular hypertension?

fibromuscular dysplasia –> young patients –> ABNORMAL GROWTH OF WALL CELLS LEADING TO NARROWING OF THE VESSEL OR BULGING –> stenosis

atherosclerosis —> older patients

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what is reno parenchymal hypertension?

hypertension due to primary kidney disease —> ACUTE OR CHRONIC

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how does OSA cause hypertension?

Typically seen in OBESE PATIENTS

Obesity is a risk factor for HYPERTENSION

50% of ppl with OSA have hypertension

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what are the complications of hypertension?

cerebrovascular disease —> Stroke due to hemorrhage or ischemia/ TIA , encephalopathy

RETINOPATHY

aneurysm

Atrial fibrillation

coronary artery disease

Left ventricle hypertrophy and heart failure

Chronic kidney disease and nephropathy –> CDK can lead to hypertension and vice versa

peripheral artery disease

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what are the grades of hypertension?

normal BP —-> 120-130 Systole , 80-84 diastole

High than normal —-> 130-139 systole , 85-89 diastole

Stage 1 hypertension —> 140-159 systole and 90-99 diastole

stage 2 hypertension —> 160-179 systole and 100-109 diastole

stage 3 hypertension —–> 180 + systole and 110 + diastole

add 20 systole and 10 diastole from stage 1

from normal to stage 1 js add 10 so 120 then 130 is higher than normal and 140 is stage 1

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what do you have to note for diabetes mellitus and coronary artery disease patients?

BP has to be below 130 / 80 otherwise it is stage 1

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what is fundoscopy and when is it required?

examination that uses magnifying lens and light to check the fundus of the eye ( retina and optic nerve )

stage1 –> 140-159/ 90-99 fundoscopy is not needed

stage 2 —-> 160-179/100-109 -FUNDSCOPY IS REQUIRED

stage 3 —> 180 + / 110+ FUNDSCOPY IS REQURIED

so fundoscopy is required for stage 2 and 3

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what is hypertensive urgency?

patient with SEVERE hypertension and symptoms BUT NO END ORGAN DAMAGE

oral medications are enough and outpatient treatment

considered hypertensive crisis

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what is hypertensive EMERGENCY?

patient with severe hypertension and SYMPTOMS but WITH ORGAN DAMAGE like acute renal failure , pulmonary edema, heart failure

I.v drugs + hospital admission IN PATIENT TREATMENT

considered hypertensive crisis

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what do you when you have different systole and diastole grading?

pick the highest one

Example patient with 150/105 bp

150 is grade 1 systole

105 is grade 2 diastole

So hes grade 2

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what is malignant hypertension and accelerated hypertension ?

old terms and now replaced with urgency and emergency

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what are the symptoms of hypertension ?

often asymptomatic for many years –> called silent killer

Screening for hypertension in the general population is recommended cuz no symptoms

sometimes is associated with :

headaches

fatigue

dizziness

tinnitus —> tinnitus medical condition for hearing noises in your ears

visual blurring

chest discomfort

Shortness of breath

Epistaxis —–> bleeding in the nose

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what is the proper way of measuring BP?

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back supported

proper cuff placement and size

cuff should not be placed over clothing

patient arm should be supported

measure from both sides but right arm is the best

Avoid caffeine, exercise , nicotine 30 minutes before measurement

both feet on the floor –> no leg crossing

normal breathing no deep breathing

when is hypertension diagnosed ?

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when measured in office and it is 140> SYSTOLE or 90+ diastole —> measure 2 times , should be at least 1 week apart and to confirm OUT OF OFFICE MEASUREMENT using Ambulatory BP monitoring or home BP measurement

Systole above 180 or diastole above 110 this is hypertension confirmed

what is ambulatory blood pressure monitoring ?

BP measuring method where a device is given to the patient and it measures the BP every 30 minutes automatically ---> 36 times a day and then gets an average if the BP is high during sleep as well then hypertension is diagnosed

what is white coat hypertension?

BP high in the clinic but normal in home or when ambulatory method in this case we either go for ABPM for 24 hours or HBPM --> patient measure two times at home one in morning and one in the evening for 7 days and we will take average

what is masked hypertension ?

Opposite to white coat high outside the office but NORMAL in the office

what is isolated systolic hypertension?

systolic is high above 140 diastole is normal below 90 common in elderly due to decreased arterial elasticity and increased stiffness

what is isolated diastolic hypertension ?

only diastolic is high but systolic is normal smokers, obese , alcoholics

what is resistant hypertension ?

uncontrolled hypertension ------> High BP despite compliance to right doses of 3 ANTI HYPERTENSION DRUGS of different classes INCLUDING diuretic ( after excluding white coat effect ) Controlled hypertension ----> BP requires 4 MEDICATIONS to achieve control

what are the hypertensive crisis?

hypertensive urgency --> stage 3 hypertension ( 180+, 110+ ) but no target organ damage Hypertensive emergency --> stage 3 hypertension WITH TARGET ORGAN DAMAGE

what are the examples of damage seen in hypertensive emergency ?

Retinopathy ---> Grade 3 or grade 4 dissecting aortic aneurysm acute LV failure with pulmonary edema Acute MI Acute renal failure eclampsia ---> seizures or coma in pregnant woman with preeclampsia ---> pregnancy with high blood pressure

what is grade 3 retinopathy?

hemorrhage and exudate visible signs of damage like bleeding and retinal hemorrhage and white patches on retina

what is grade 4 retinopathy ?

papilledema disease entity that refers to the swelling of optic disc due to elevated intracranial pressure ( ICP )

what are the types of hypertension in pregnancy?

Chronic hypertension gestational hypertension pre- eclampsia Eclampsia

describe chronic hypertension in pregnancy? ?

High Bp before pregnancy High BP in pregnancy BEFORE W20 continue for at least 12 weeks POST PARTUM

describe gestational hypertension in pregnancy?

High BP in 2nd half of pregnancy AFTER W20 NO PROTEINURIA continues up to 6 WEEKS postpartum

describe pre ecampsia in pregnancy?

Hypertension + PROTEINURIA edema AFTER w20 of pregnancy

what is eclampsia in pregnancy?

same as pre eclampsia BUT With seizures and coma

what are the non pharmacological treatment of hypertension ?

Weight lose ( 1kg loss = 1 mmhg systole reduced ) ---> reduce calorie intake and exercise Diet recommendation : reduce systole by 10 mmhg Low sodium intake High potassium and protein intake LOW fat and sugar Smoking cessation limit consumption of alcohol Limit caffeine intake regular physical activity --> reduce 5 mmhg meditation / relaxation practice

what are the characteristics of hypertension drug ?

Once daily for 24 hours BP control --> mono or combination therapy least possible adverse effects profile evidence based prognostic benefits affordable cost

when do we start hypertension medications ?

Stage 2 hypertension stage 1 hypertension with DM or CVD 10% > risk of developing CVD in 10 years

what are the goals of hypertension medications ?

reduce BP to below 140/90 reduce it to 130 /80 in DM or CVD or 10% risk patients results should appear within 3 months

what are the first line medications for hypertension ?

ACE inhibitors / ARBs Thiazide diuretics CCB

what are the second line drugs ?

Loop diuretics --> frusemide and K+ SPARING DIURETICS BB , Alpha blockers central alpha 2 agonist direct vasodilator direct renin inhibitors

what are k+ sparing diuretics ?

eplerenone Spironolactone

what are the drugs used in step 1 to step 3 in management of hypertension?

1st line drugs --> ACE, CCB , Diuretics step 1 ---> use 1 from them step 2---> use any 2 of them step 3 ----> combine all 3 step 4 you use 2nd line medications

when are ACEIs and ARBS used as 1st line treatment?

diabetes Ischemic heart disease chronic kidney disease systolic HF

when are beta blockers used ?

Systolic HF improve survival

when are mineralocorticoid receptor antagonist used ?

systolic HF with normal renal function

when are diuretics used?

Volume overload control in HF or CKD

what drugs are used in african american / african descent patients ?

CCB --> even if diabetic thiazides diuretics hydralazine ( Vasodilator )

what drugs are used in pregnant women?

methyldopa labetalol nifedipine ---> NICARDEPINE ---> NO REFLEX TACHYCARDIA

what is the treatment for hypertension emergency?

ICU admission I.V anti hypertensive medications

what is the target of therapy in hypertensive emergency ?

reduction of systolic BP by 25% within 1 hour reduction of systolic BP by 5-10% within the next 23 hours followed by oral drugs and titrate dose while wearing off i.v medications <140/90 within 48 hours with oral medications

whats the target in MI, ECLMAPSIA ?

Reduce Systolic BP to below 140 within 1 hour

what is the target in aortic dissection ?

reduce systolic BP to below 120 in ONE HOUR

Hypertension Flashcards

(57 cards)