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Hypertension Flashcards

What are the Framingham Criteria (66 cards)

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1
Q

What are the main causes of death in hypertensive patients

A

Stroke 45%
Heart Failure 35%
Kidney Failure 3%
others 17%

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2
Q

What factors increase the risk of dying in hypertensive patients

A

male
young
family hx
increasing diastolic pressure

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3
Q

What is malignant hypertension

A

Diastolic >120mmHg and exudative vasculopathy retinal and kidney circulations.

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4
Q

What is refractory Hypertension

A

BP >140/90mmHg despite max dosage of two drugs for >3-4months

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5
Q

What is Essential Hypertension

A

presence of sustained hypertension in the absence of underlying, potentially correctable kidney, adrenal or other factors.

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6
Q

What is grade 1 hypertension (mild)

A

140-159/90-99

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7
Q

What is Grade 2 Hypertension (moderate)

A

160-179/100-109

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8
Q

What is grade 3 hypertension (severe)

A

> 180/>110

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9
Q

How do you stratify CV risk

A

based on BP level, absolute CV risk factors, assoc clinical conditions, target organ damage

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10
Q

How common is Essential HTN verse Secondary HTN

A

Essential HTN is the cause in 90-95% of all HTN patients

Secondary HTN is implicated in 5-10% of cases.

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11
Q

What are the causes of secondary Hypertension

A 
Kidney, 
ENdocrine,
 misc (Coarctation of the aorta, Immune disorder (e.g. polyarteritis nodosa),
 Drugs (NSAIDs, corticosteroids)
Pregnancy
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12
Q

What Endocrine causes of HTN are there

A 
Primary Aldosternoism (conn Sydx
Cushing Syndrome
Phaeochromocytoma
oral contraceptives
other endocrine factors
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13
Q

what kidney causes of HTN are there

A 
glomerulnephritis
reflux nephropathy
kidney artery stenosis
diabetes
other renovascular dx
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14
Q

What clinical features would you look for as a cause of secondary hHTN

A
  • abdominal systolic bruits (Kidney artery stenosis)
  • proteinuria, haematuria, casts (glomerulonephritis)
  • Bilateral kidney massess +/- Haematuria (polycystic dx)
  • Hx of claudication and delayed femoral pulse (coarctation of aorta)
  • progressive nocturia, weakness (Primary aldosteronism)
  • paroxysmal hypertension with headache, pallor, sweating, palpitations (phaeochromocytoma)
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15
Q

How would you investigate for renal artery stenosis?

A

Arterial artery Doppler USS

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16
Q

What symptoms would indicate possible end organ damage from HTN

A 
headache
dyspnoea
cehst pain
claudication
ankle oedema
haematuria
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17
Q

What pro-hypertensive medications are there?

A 
Oral & depot contraceptives
HRT
steroids
NSAIDs/COX 2 inhibitors
nasal decongestants and other cold remedies
appetite suppressants 
amphetamines
MAOI
ergotamine (migraine Rx)
cyclosporin (immune supressor - organ transplant)
tacrolimus (immunosupressant)
carbenoxolone & liqourice
buproprion (anti smoking pill)
sibutramine (diet pill - no longer available)
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18
Q

What routine tests would you perform in a pt with elevated BP

A 
BSL
Lipid studies (complete)
Serum creatinine/eGFR
serum uric acid
serum potassium and sodium
Hb and Haematocrit
U/A (& urinary sediment)
ECG
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19
Q

What tests would be recommended in HTN

A 
Echo
Carotid/femoral US
postprandial BSL
CRP
Microalbuminuria
Quantatative Proteinuira (if U.A Positive)
Fundoscopy
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20
Q

what are the benefits of BP control

A

reduces CV and total mortality
reduces stroke
reduces coronary events
this is true of all types of BP

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21
Q

what are some non-pharmacological life-style mx options

A
  • weight loss
  • Alcohol - reduction of excessive alcohol intake - increases the BP and makes Rx harder - can reduce BP by 5-10mmHg
  • Reduce Na intake - (<100mmol/day)
  • increased exercise - walking ok, avoid weights and other forms of isomeric exercises as they incr BP
  • stress reduction - either avoid or reduce with meditation/relacxtion
  • diet - avoid liquorice, lacto-vegan diet or high calcium, low fat, low caffeine may be beneficial
  • smoking - may negate any Rx benefits
  • Mx sleep apnoea
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22
Q

What would you start a new HTN pt on?

A

ACEI or ARB
or Ca Chanel blocker (CCB)
or low dose thiazide diuretic (if >65yrs)

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23
Q

If pt fails initial drug what second line agent would you use

A

ACEI or ARB + CCB
or
ACEI or ARB + thiazide

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24
Q

If target not reached with 2 drugs what would you then give

A

ACEI/ARB & CCB & Thiazide

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25
What combinations of antihypertensives should you not use.
ACEI/ARB & K+ sparing diuretic - causes hyperkaleamia or More than one drug from same family - eg. B-Blockers and Verapamil - causes heart block/failure
26
What combination of antihypertensives are not very effective
diuretic and CCB | B-Blockers and ACEI
27
What diuretics are a good first line choice
Thiazides
28
when would you not use a thiazide and why?
In pt with kidney impairment - less effective T2DM Hyperuricameia
29
what diuretic would you use in a patient with cardiac or kidney failure
loop diuretic
30
what Thiazde diuretics are there?
Indapamide hydrochlorothiazide chlorathalidone
31
What B-Blockers are there
Atenolol Metoprolol pindolol propranolol
32
what Calcium chanel blockers are there
``` amlodipine diltiazem felodipine lercandipine nifedipine Verapamil ```
33
What ACE inhibitors are there
ramipril captopril enalapril lisinopril
34
What ARBs are there?
irbesartan | losartan
35
when would you use a central acting agent and what options are there?
Pergnancy and asthma, Methyldopa Clonidine
36
What alpha-blockers are there
Prazosin Terasozin Labetalol (alpha and beta blocer)
37
what hypertensive agent my precipitate gout
thiazide diuretic
38
why should you not have NSAIDs if Hypertensie
NSAIDS reduces the effects of diuretics
39
why would you choose indapamide over the other thiazides
Less effect on serum lipids
40
what could taking Verapamil and B-Blocker result in
Heart block by uncovering a conduction abnormality
41
what effect does stopping a B-blocker in someone with likely IHD do
can cause Angina at rest
42
How do Calcium Chanel blockers work?
vadodilation
43
Can CCb be used with a B-Blocker?
Only some - Verapamil and diltiazem slow the heart so should not be used with B-Blockers
44
When is it not safe to use verapmil
in 2nd and 3rd heart block
45
what effect does NSAID have on B-Blockers?
reduces its hypotensive effect
46
If one b-blocker has failed to reduce HTN sufficiently would changing to another be useful?
No. If one has failed, another is unlikely to have a different effect.
47
what are the downsides to using the calcium channel blockers - nifedipine and felodipine?
They have more vasodilation than other druge therefore more side effects
48
are calcium channel blockers of the dihydropiridine compounds (nifedipine and felodipine) safe to use with B-blockers?
Yes
49
How does ACE-I work?
ACE converts Angiotensin I into Angiotensin II (which acts a vasoconstrictor and stimulates aldosterone secretion), and breaks down Bradykinin (a vasodilator)
50
how common is the ACE-I induced cough?
15% of patients
51
does the ACE-I cough decrease with time or dose
Sometimes
52
When else would you consider using an ACE-I outside of HTN?
In diabetics with microalbuminuria, Even if normotensive.
53
Can you use ARBS with Thiazide diuretics?
Yes
54
why would you choose an ARB over an ACE-I
Generally ACE-I are better but if pt has discontinued due to cough then ARB is a good alternative as they have similar kidney protecting profiles
55
What do you need to warn pts about, when starting Prazosin?
That for their first dose they may have an acute syncopal episode after 90 minutes. Therefore should take it at night before bed
56
in which patients would you consider Prazosin as a first line Rx?
in those patients unsuitable for diuretics or B-Blocker therapy eg. diabetics, asthma or hyperlipidaemia
57
Can you use Prazosin with B-Blockers?
Yes - they actually increase the effect of B-Blockers and if possible should be used together.
58
what vascular smooth muscle relaxants are there?
Calcium channel blockers hydralazine minoxidil diazoxide
59
When would you use vascular smooth m.m relaxants?
In refractory HTN or HTN emergencies.
60
What affect does aldosterone have on the body?
vasoconstirction an dvascular remodellin
61
How would you treat a pt with mild HTN
avoid medication as much as possible due to likely risks outweighing benefits non-pharmacological Rx If not successful in 6 months then Rx with medication
62
What drugs are preferred in management of isolated systolic HTN
ACE-I, Ca - channel blocker, and/or diuretics
63
when treating hypertension in the elderly what is the first line treatment option
indapamide or low dose thiazide diuretic review in 2-4 weeks and if hypokaleamia develops add a K-sparing diuretic feather than K supplements
64
what type of drug is frusemide
a loop diuretic
65
what antihypertensive agents are assoc with erectile dysfunction
B-Blocker, thiazide diuretics, methyldopa, resrpine,
66
what antihypertensive agents would you use in a pt with Erectile dysfunction
ACE-I, and calcium channel blockers

Cardiology (10 decks)

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