Hypertension Flashcards Preview

Cardiology > Hypertension > Flashcards

Flashcards in Hypertension Deck (30):
1

How is the decision made whether to a treat hypertensive patient?

Treat all patients with BP>160/100
If patients have BP>140/90, the decision depends on the risk of coronary events, presence of diabetes or end organ damage

2

What is the most common form of hypertension in the UK? What causes it?

Isolated systolic hypertension
Caused by stiffening of the large arteries- arteriosclerosis

3

What is malignant or accelerated phase hypertension?

Rapid rise in BP leading to vascular damage

4

What is the pathological hall mark of accelerated phase hypertension?

Fibrinoid necrosis

5

What are the signs of accelerated phase hypertension?

Severe hypertension (systolic >200, diastolic >130)
Bilateral retinal haemorrhages and exudates +/- papilloedema

6

What are the symptoms of accelerated phase hypertension

Head aches
Visual disturbance

7

What hypertensive emergencies may be caused by accelerated phase hypertension?

Acute renal failure
Heart failure
Encephalopathy

8

What is meant by the term "essential hypertension"? How common is it?

Primary cause is unknown
Approx 95% of cases

9

What are causes of secondary hypertension

Renal disease: Most common secondary cause
Endocrine disease
Other causes (pregnancy; OCP; steroids; coarctation)

10

What are renal causes of hypertension

75% form intrinsic renal disease: golmerulonephritis; polyarteritis nodosa- PAN, systemic sclerosis; polycystic kidneys; chronic pyelonephritis

25% due to renovascular disease, most commonly atheromatous- elderly, male, cigarette smokers

11

What are endocrine causes of hypertension?

Cushing's
Conn's
Phaeochromocytoma
Acromegaly
Hyperparathyroidism

12

What tests should be done in a hypertensive patient?

To quantify overall risk: fasting glucose; cholesterol

To look for end organ damage: ECG (LV hypertrophy; past MI); urine analysis (protein, blood);

To exclude secondary causes: U&Es (low potassium in Conn's for e.g.); Calcium (high in hyperparathyroidism)

Special tests: Renal ultrasound/arteriography to look for renal artery stenosis. 24 hour urinary metanephrines, Urinary free cortisol. Renin. Aldosterone.

24 hour ambulatory BP monitoring- helpful in white coat syndorme or borderline hypertension. Now recommended in all newly diagnosed hypertensives.

13

How is hypertensive retinopathy graded?

I: Tortuous arteries with thick shiny walls
II: AV nipping - narrowing where arteries cross veins
III: Flame haemorrhages and cotton wool spots
IV: papilloedema

14

What is the treatment goal for BP in hypertension

80

15

What is first choice therapy for black patients of any age and for patients >55 years?

Calcium channel blocker or thiazide

16

What is first choice therapy for patients <55 years?

ACEi or ARB if ACEi intolerant

17

When might beta-blockers be used as first line treatment in hypertension?

In younger people, particularly:
- If intolerant to ACEi and ARB
- If patient is a woman of child bearing potential
- If there is increased sympathetic drive

18

What is combination therapy for hypertension?

ACEi + calcium channel blocker or thiazide

19

If a patient is only on a beta blocker and a second drug is needed, what drug should be chosen? What drug should not be chosen and why?

Calcium channel blocker should be chosen
Not thiazide to reduce risk of diabetes

20

If hypertension is still uncontrolled in a patient taking ACEi, calcium channel blocker and thiazide. What treatment options should be considered?

1. Higher dose thiazide
2. Add another diuretic e.g. spironolactone- monitor potassium
3. Add beta blocker
4. add selective alpha-blocker

21

What are the side effects of thiazides?

Low potassium and sodium
Impotence
Diabetes

22

When are thiazides contraindicated?

Gout

23

What are the side effects of calcium channel blockers?

Flushes
Fatigue
Gum hyperplasia
Ankle oedema

24

When are ACEi contraindicated?

bilateral renal artery or aortic valve stenosis

25

What are the side effects of ACEi's?

Cough
Hyperkalaemia
Renal failure
Angio-oedema

26

Why should blood pressure be reduced slowly?

Sudden drops in BP carry high risk of stroke

27

What are signs and symptoms of encephalopathy?

Headache
Focal CNS signs
Siezures
Coma

28

How should high BP be managed in the context of encepalopathy?

Aim to reduce BP to 110mmHg diastolic over 4h
Admit to monitored area
Insert intra-arterial line for pressure monitoring
Administer furosemide IV
Then either IV labetalol or sodium nitroprusside infusion

29

What is the main risk of sodium nitroprusside infusion?

Cyanide poisoning

30

Why should subligual nifedipine not be used to lower BP

It causes a large drop in BP--> stroke risk