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Cardio: T15 Dyslipidaemia And Hypertension > Hypertension > Flashcards

Hypertension Flashcards

(48 cards)

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1
Q

When hypertension decreases renin secretion causes?

A

Natriuresis

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2
Q

Phenotypes associated with

salt-sensitive hypertension

A 
Low renin Hpt (Primary)
Black ethnicity
Older age
Obesity
Metabolic syndrome
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3
Q

What can cause a natriuretic handicap?

A

Sodium Channelopathies
Genetics (APOL1 gene variants)
Renal injury
Low nephron mass

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4
Q

What can cause renal injury?

A

Sympathetic system
Uric acid
High salt diet

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5
Q

When is ambulatory BP monitoring indicated?

A

For the evaluation of “white coat” HTN (in absence of target organ injury)

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6
Q

If there is an absence of a BP drop while sleeping, it could indicate?

A

Increased CVD risk

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7
Q

Circumstances needed for office BP measurement

A 
No coffee 30min before
Pt seated quietly 5min
Arm supported at heart level
Appropriate sized cuff
At least 2 measurements
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8
Q

Uses for self-measurment of BP

A

Check response to antihypertensive Rx
Improve adherence with Rx
Evaluate ‘white coat’ HTN

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9
Q

3 objectives when evaluating a pt. with HTN

A

Identify other CV risk factors or concomitant disorders that affects prognosis and guides treatment
Reveal identifiable causes of high BP
Assess the presence or absence of target organ damage and CVD

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10
Q

Name some CVD risk factors

A 
Metabolic syndrome components
Smoking
Inactivity
Microalbuminuria/GFR<60
Age
Family history of premature CVD
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11
Q

Name some identifiable causes of HTN

A 
Sleep apnea
Drug-induced
Chronic kidney disease
Chronc steriod Rx (Cushing's)
Pheochromocytoma
Coarctation of the aorta
Thyroid/parathyroid disease
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12
Q

Name some possible effects of target organs damage

A 
LVH, Angina, prior MI, HF, Prior coronary revascularization
Stroke, transient ischaemic attack
Chronic kidney disease
Peripheral artery disease
Retinopathy
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13
Q

Important aspects on clinical exam

A

Fat distribution and muscle strength
Peripheral pulses
Wheezes and crackles
Renal masses and bruits

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14
Q

Lab tests for HTN

A 
ECG (LVH)
Urinalysis (albumin:creatinine)
Glucose, hematocrit
Creatinine, GFR
Lipid profile
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15
Q

How does the sympathic nervous system respond to a decrease in BP?

A

It stimulates the activation of both the B1 adrenoceptors of the heart and the A1 adrenoceptors on smooth muscle

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16
Q

How does the renin-angiotensin-aldosterone system respond to a decrease in BP?

A

The decrease in renal blood flow causes:

  1. An increase in renin and therefore angiotensin secretion which increases aldosterone secretion
  2. decrease in GFR causing increase in retention of sodium and water
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17
Q

5 classes of anti-hypertensive drugs

A 
Diuretics
ACE-I
ARB
Sympatholytics
Calcium channel blockers
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18
Q

What is Furosemide’s MOA?

A

Inhibits Na-K-Cl co-transporter

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19
Q

How do thiazide diuretics decrease BP?

A

They decrease peripheral resistance and sodium retention

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20
Q

What are the AE of hydrochlorothiazide?

Study These Flashcards
A

Decrease K and Na
Hyperuricaemia and gout
High doeses - glucose intolerance and adverse lipid profile

21
Q

Classes of ACE-I

Study These Flashcards
A
  1. Captopril
  2. Prodrugs: enalapril
  3. Water-soluble: lisinopril
22
Q

ACE-I can cause coughing as they prevent the metabolism of?

23
Q

AE of ACE-I

Study These Flashcards
A

Coughing
Othostatic HTN
Hyperkalaemia
Angioedema

24
Q

C/I of ACE-I

Study These Flashcards
A

Pregnancy

Renal artery stenosis

25
What important AEs of ACE-I is not found when using ARBs?
Coughing | Angioedema
26
2 e.g. of ARBs
Losartan | Volsartan
27
Egs of sympatholytics
B1 and B2: propranolo, nadolol | B1: atenolo, bisoprolol, metoprolol
28
How do sympatholytics decrease BP?
They decrease renin secretion and activity of B1 on the heart
29
When are B-blockers used?
Not recommended unless compelling indication
30
AE and C/I of B-blockers
``` Asthmatics IDDM Heart block Verapamil Symptomatic CCF ```
31
Eg of calcium channel blocker
Nifedipine | Verapamil
32
CCB C/I
Tachycardia Hypotension Unstable angina/acute MI B-blockers
33
Stepwise approach to HTN Rx
Lifestyle modification Low dose HCTZ ACE-I/ARB Long acting CCB
34
When can combination Rx be considered from the start?
If BP>20/10 above goal
35
Compelling indications for diuretics
HF Elderly Isolated systolic HTN Africans respond well
36
Compelling indications for ACE-i & ARB
HF Post MI Non-diabetic & diabetic nephropathy Proteinuria
37
Compelling indications for B-blockers
Angina pectoris Post MI HF (unless bradycardia or poorly controlled) - carvedilol, metoprolol & bisoprolol Tachyarrythmias
38
Compelling indications for CCB
Isolated systolic hypertension Peripheral vascular disease Stable angina Pregnancy (nifedipine)
39
Drugs that cause HTN
``` NSAIDs Sympathomimetics: Nasal decongestants & appetite suppressants Cocaine, amphetamines, caffeine Liquorice Cyclosporine, tacrolimus, EPO •MAO-I, TCA ```
40
Who to treat with anti-hypertensive drugs?
If repeated BP >140/90 | If DM/chr renal failure BP >130/80
41
What is usually measured during follow-ups for HTN?
Serum potassium and creatinine
42
Special situations for HTN Rx
``` Women, elderly, children and adolescents Black pts Metabolic syndrome LVH PVD Postural hypotension ```
43
BP management with LVH
Weight loss Sodium restriction All drug classes (not hydralazine, minoxidil)
44
Aspirin should be used with HTN in the case of?
PVD
45
Postural hypotension is more frequently seen in older pts wiith?
DM Diuretics Venolators Psychotrpoic drugs
46
Favorable effects of anti-hypertensive drugs
Thiazide diuretics: slows osteoporosis BBs: AF, thyrotoxicosis, perioperativee HTN CCBs: Raynaud's, arrhythmias A-blockers: prostatism
47
Unfavorable effects of anti-hypertensive drugs
Thiazide diuretics: cautious in gout, Hx of hyponatremia BBs: avoid in pts with asthma, reactive airways disease, 2nd or 3rd degree block ACEIs/ARBs: C/I pregnancy (incl. future) ACEIs: not used if Hx of angioedema Aldosterone antagonists and potassium-sparing diuretics can cause hyperkalemia.
48
Causes of resistant HTN
``` Improper BP measurement Excess sodium intake Inadequate medication Drugs that worsen HTN Excess alcohol intake Identifiable causes of HTN ```

Cardio: T15 Dyslipidaemia And Hypertension (4 decks)

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