Flashcards in Hypertension Deck (60)
What would a blood pressure greater than be classed as hypertension?
Name two types of hypertensikon that are related to normal variation in individuals?
1. White coat hypertension
2. Stable or labile hypertension
What causes cardiac failure?
Give four conditions hypertension is a risk factor for?
1. Cerebral haemorrhage
3. Renal failure
4. Sudden cardiac death
What populations is hypertension higher in?
According to consequences what are the two classes of hypertension?
What do heart rate, contracility and blood volume control?
What do constrictors such as angiotensin II and catecholamines, and dilators such as NO and prostaglandins control?
What does increase in dietary salt lead to?
Increase in BP
In renal disease, what is two year hypertension usually?
What do renal disease, endocrine disease, aortic disease, renal artery stenosis and drug therapy all have the potential to cause?
What can renal artery stenosis, acute or chronic glomerulonephritis, chronic pyelonephritis, cystic diseases and interstitial nephritis all cause?
1. Reduced renal blood flow
2. Excess renin release
3. Salt and water overload
Give 4 endocrine causes of secondary hypertension
1. Adrenal gland hyperfunction/tumours
2. Conn's syndrome - excess aldosterone
3. Cushing's syndrome - excess corticosteroid
4. Phaechromocytoma - excess noradrenaline
What can coarctation of the aorta lead to and what is it?
Congenital narrowing of segments of the aorta
What can corticosteroids cause?
What type of hypertension eventually causes, left ventricular hypertrophy, congestive cardiac failure, increased atheroma, increased aneurysm rupture (aortic dissection, Berry aneurysm) and renal disease?
What does hypertension eventually cause in the heart?
Left ventricular hypertrophy
What does increased left ventricular load, poor perfusion, intestitial fibrosis, micro-infarcts and diastolic dysfunction cause?
Left ventricular hypertrophy
What two major things can left ventricular hypertrophy cause?
1. Sudden cardiac death - arrythmia and poor perfusion
2. Cardiac failure
What does hypertension eventually do to tissue?
What can cause a subachnoid haemorrhage?
Rupture of Berry aneurysm
What is the term for plasma proteins being forced into vessel walls (clinical feature of ageing)?
What type of hypertension involves diastolic pressure above 130/140?
What 5 things result from malignant hypertension?
1. Cerebral oedema - seen as papilloedema (swelling of optic disc)
2. Acute renal failure
3. Acute heart failure
4. Headache and cerebral haemorrhage
5. Blood vessels show fibrinoid necrosis and endarteriris proliferans of their walls
What is pre-eclampsia?
Hypertension and proteinuria
What is this a definition of - a disorder in which the level of sustained arterial pressure is higher than expected for the age, sex, and race of the individual?
Before measuring the BP what should you check on the patient?
Pulse - for irregularity
What should you offer if clinic BP is 140/90 or higher?
Abulatory blood pressure monitoring (ABPM) to confirm the daignosis of hypertension
If the reading of BP is different between both arms by more than 20 mmHg what do you do?
Repear the measurements
If the person is unable to tolerate ABPM what do you suggest?
Home blood pressure monitoring
What must hypertension be diagnosed using?
When using ABPM to confirm hypertension diagnosis what should you ensure?
At least two measurements per hour during the person's usual waking hours
When diagnosis hypertension using HBPM, what three things should you ensure?
1. Two consecutive seated measurements, 1 minute apart
2. BP is recorded twice a day for at least 4 days and preferably for 7
3. Measurements on hte first day are discarded - average value of all remaining is used
In stage I hypertension - what is clinic BP and ABPM or HBPM?
Clinic BP - 140/90 or higher
ABPM or HBPM - daytime average is 135/85 or higher
In stage II hypertension - what is clinic BP and ABPM or HBPM daytime average?
Clinic BP - 160/100 or higher
ABPM or HBPM daytime average is 150/95 or higher
For severe hypertension - what is clinic BP?
Clinic BP - 180 mmHg or higher
Clinic diastolic is 110 mmHg or higher
What 4 tests should be done for all patients with hypertension?
1. Test urine for presence of protein
2. Take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
3. Examine fundi for hypertensive retinopathy
4. Arrange ECG
Give 4 signs of end organ damage as a result of hypertension?
1. Left ventricular hypertrophy
2. Creatinine raised
What four features can be seen in hypertensive retinopathy grade IV?
Cotton wool spot
For people under 55 years, with hypertension - what treatment is offered?
Antihypertensive treatment with ACE inhibitor or ARB
What two drugs should not be combined to treat hypertension?
ARB and ACE inhibitor
For people over 55 years, with hypertension or black people (African/Caribbean) what treatment is given?
Calcium channel blocker, if not tolerated offer thiazide diuretic
In stage 1 treatment, if it is not controlled offer stage 2 - what is stage 2?
Offer calcium channel blocker alongisde ACE inhibitor or ARB
For black carribean and african hypertensive patients, what should be considered in combination with calcium channel blocker?
In relation to monitoring drug treatment - what should be aimed for in people aged under 80?
For monitoring drug treatment, what should be aimed for in people over 80?
Is obstructive sleep apnoea a cause of secondary hypertension?
When there is confirmed primary aldosteronism - what investigation should be done?
Adrenal CT scan
What are the 5 main drugs used for hypertensive treatments?
1. Thiazide diuretics
2. ACE inhibitiors
4. Calcium channel blockers
5. Beta blockers
What are two lesser used drugs for hypertension?
What drugs are used in angina?
2 drugs used for congestive cardiac failure?
1. ACE inbibitors
What two drugs are used for hypertension in diabetic nephropathy?
ACE inhibitors and ARBs
What antihypertensives are used in prostatism?
What antihypertensives are used in the elderly?
For step three treatment of hypertension what three drugs should be used?
1. ACE inhibitor
2. Calcium channel blocker
3. Thiazide diuretic
For step 4 hypertension treatment, what should be added in addition to ACE inhibitors, calcium channel blockers and thiazide diuretics?
Spironolactone low dose
For step 4 treatment of hypertension, if further diuretic therapy is not tolerated what should be added?
Beta or alpha blockers
What drug fits the phrase, "start low, go slow"?