Flashcards in Hypertension Deck (57):
How is hypertension defined.
Defined as blood pressure > 140/90mmHg.
What are the two main categories of hypertension. (2)
What is essential hypertension.
Arterial hypertension with no specific cause.
What percentage of cases of hypertension are due to essential hypertension.
What are the causes of secondary hypertension. (5)
Coarctation of the aorta.
What are the endocrine causes of hypertension. (5)
What are the renal causes of hypertension. (2)
Chronic renal failure.
Renal artery stenosis.
What are the iatrogenic causes of hypertension. (3)
What are the risk factors for hypertension. (5)
Increased salt intake.
What are the symptoms of hypertension. (9)
Asymptomatic unless malignant.
Signs of heart failure.
And symptoms related to the underlying cause.
What are the signs of hypertension. (6)
4th heart sound.
3rd heart sound.
What investigations should be carried out in a patient with hypertension. (9)
Haemoglobin A1c (HbA1c).
Urine for sugar/protein/blood/creatinine clearance.
ECG (for LV hypertrophy and strain).
Other investigations to rule out secondary causes.
What tests should you do to rule out Cushing's as a cause of hypertension. (4)
Dexamethasone suppression test.
What test should you do to rule out a phaeochromocytoma as a cause of hypertension.
24 hour urine for catecholamines.
What test should you do to rule out a renal carcinoid as a cause of hypertension.
24 hour urine for hydroxyindoleacetic acid (HIAA).
What test should you do to rule out Conn's as a cause of hypertension.
What tests should you do to rule out renal artery stenosis as a cause of hypertension. (2)
Renal Doppler flow studies.
What are the complications of hypertension. (5)
What are the main aspects of treatment of hypertension. (2)
What aspects of a patient's lifestyle should be changed if they have hypertension. (5)
Reduce alcohol intake.
Optimize glycaemic control.
What are the medical therapies for patient with hypertension. (7)
ACE inhibitors (Lisinopril).
Angiotensin receptor blockers (candesartan).
Calcium channel blockers (nifedipine).
Beta blockers (bisoprolol).
Aspirin when BP controlled if age>55.
What is malignant hypertension considered.
A medical emergency.
What is malignant hypertension.
Fibrinoid necrosis of small arteries/arterioles and dilatation of cerebral arteries.
Who is most affected by malignant hypertension.
Men more than women.
Usually in the 5th decade.
What are the clinical signs of malignant hypertension. (5)
What is the treatment of malignant hypertension. (2)
Slow reduction of blood pressure.
What are the complications of malignant hypertension. (7)
Microangiopathic haemolytic anaemia.
Acute renal failure.
Who gets treatment for hypertension.
Everyone above 160/100.
For those with BP 140/90, the decision to treat depends on the risk of coronary events, presence of diabetes or end-organ damage.
What did the HYVET study show.
That there is a substantial benefit in treating those with hypertension over 80s.
What is isolated systolic hypertension.
It is the most common form of hypertension in the UK.
What is the prevalence of isolated systolic hypertension.
It affects 50% of those over 60.
What is isolated systolic hypertension caused by.
It results from stiffening of the large arterial vessels (arteriosclerosis).
Is isolated systolic hypertension malignant.
What does isolated malignant hypertension increase the risk of. (2)
It doubles the risk of MI.
It triples the risk of CVA.
What is the aetiology of malignant hypertension.
It refers the a rapid rise in BP, leading to vascular damage (pathological hallmark is fibrinoid necrosis).
What are the hallmark features of malignant hypertension. (3)
Severe hypertension (systolic>200, diastolic >130).
Bilateral retinal haemorrhages and exudates.
Papilloedema may or may not be present.
What are some hypertensive emergencies. (3)
Acute renal failure.
What is the mortality for malignant hypertension. (2)
Untreated, 90% die in one year.
70% survival 5years.
Who is malignant hypertension most common in. (2)
What percentage of hypertensive cases are due to secondary hypertension.
What is the most common secondary cause of hypertension.
What indicates severity and duration of hypertension.
If there are any signs of end organ damage.
What are some signs of end organ damage in hypertension. (3)
What test helps in a borderline hypertensive patient.
24h ambulatory BP monitoring.
It is now recommended for all newly diagnosed hypertensive cases.
Why are tests done in a patient with hypertension. (3)
To help quantify overall risk.
To look for end-organ damage.
To 'exclude' secondary causes.
What are some other causes of secondary hypertension. (5)
What are the grades of retinopathy.
Grade 1 to 4.
What is grade 1 retinopathy characterized by.
Tortuous arteries with thick shiny walls (silver or copper wiring).
What is grade 2 retinopathy characterized by.
A-V nipping (narrowing where arteries cross veins).
What is grade 3 retinopathy characterized by.
Flame haemorrhages and cotton wool spots.
What is grade 4 retinopathy characterized by.
What is stage 1 hypertension.
What is stage 2 hypertension.
What are the signs of encephalopathy. (4)
What is the pattern of adding drugs for hypertensive patients. (4)
ACEi and Calcium channel blocker.
Add thiazide diuretic.
If a fourth is needed add a higher dose thiazide diuretic or another diuretic (spironolactone).
If only a beta blocker and another drug is needed to control hypertension, what drug should be added.
Calcium channel blocker, not a thiazide, to reduce the risk of developing diabetes.