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Cardiovascular system > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what end organ damage can high blood pressure cause?

A 
> brain: stroke, cognitive decline, haemorrhage
> eye: retinopathy
> veins: peripheral vascular disease
> kidneys: renal failure, proteinuria
> heat: MI, LVH, CHD, CHF
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2
Q

what is the definition of hypertension?

A

Blood pressure above which the benefits of treatment outweigh the risks of morbidity and mortality

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3
Q

what is the parameters for stage one hypertension?

A

clinical blood pressure of 140/90 mmHg or higher and an ABPM daytime average 135/85 mmHg or higher

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4
Q

what is stage 2 hypertension?

A

clinical blood pressure is 160/100 mmHg or higher and ABPM daytime average is 150/95 mmHg or higher

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5
Q

what is severe hypertension?

A

a clinic systolic blood pressure is 180mmHg or higher or the diastolic pressure is 110mmHg or higher.

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6
Q

what is the cause of primary hypertension?

A

there is no cause that can be found

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7
Q

name some causes of hypertension?

A

> chronic renal disease
renal artery stenosis
endocrine disease

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8
Q

how do risk factors affect the morbidity from blood pressure

A

they increase in exponentially but and there is a baseline risk for all ages

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9
Q

name some factors that increase the risk form hypertension

A 
> smoking
> diabetes mellitus
> renal disease
> hyperlipidaemia
> previous MI/stroke
> left ventricular hypertrophy
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10
Q

what are the prime contributors to blood pressure?

A

> cardiac output: stroke volume and heart rate

> peripheral vascular resistance

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11
Q

how does the sympathetic system increase blood pressure?

A

> vasoconstriction
tachycardia
increased cardiac output

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12
Q

what happens if the sympathetic effect is maintained for long periods of time?

A

it can become permanent resulting in a higher blood pressure

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13
Q

what is the renin-angiotensin-aldosterone system responsible for controlling?

A

> sodium balance
blood pressure
blood volume

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14
Q

what stimulates the renin-angiotensin-aldosterone system?

A

> fall in blood pressure
fall in circulating volume
sodium depletion

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15
Q

where is renin released from?

A

the jaxtaglomerular apparatus

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16
Q

what are the properties of angiotensin 2?

A

> vasoconstrictor
it is an anti-natriuretic peptide and anti-diuretic peptide
stimulator of aldosterone release from adrenal glands

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17
Q

angiotensin 2 is also a hypertrophic agent. what is the effect of this?

A

this stimulates myocyte and smooth muscle hypertrophy in arterioles. this creates narrow lumens that cannot dilate and become stiff. this could result in them splitting.

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18
Q

give 4 examples of the aetiology of hypertension

A

> polygenic: major genes and poly genes

> polyfactorial: environment and individual/shared

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19
Q

how would a hereditary defect in the smooth muscle lining of arterioles affect the blood pressure?

A

it is likely to cause increased reactivity of resistance vessels and resultant increase in peripheral resistance

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20
Q

describe the sodium homeostatic effect

A

in essential hypertension the kidneys are unable to excrete the appropriate amounts of sodium for any given blood pressure. sodium and fluid are then retained causing an increase in blood pressure.

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21
Q

why does blood pressure tend to increase with age?

A

there is decreased arterial compliance

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22
Q

in what family relations does the closest correlation of hypertension exist?

A

between siblings

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23
Q

how many genes are important to hypertension?

A

> 30 but they only account for 0.5mmHg each

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24
Q

what is the effect of salt intake reduction to blood pressure?

A

it does lower BP in hypertensive patients but has no real effect on people with normal blood pressure

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25
Q

how does alcohol effect the blood pressure?

A

small amounts decrease the blood pressure but large amounts increase the blood pressure.

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26
Q

what is the average fall in blood pressure due to reduction in alcohol consumption?

A

5/3mmHg

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27
Q

by how much would an untreated patients BP fall if they were to lose 9kg?

A

by 19/18 mmHg

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28
Q

what is the effect of birth weight on hypertension?

A

low birth weight creates a higher likelihood of developing hypertension and heart disease

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29
Q

what can sustained hypertension lead to?

A

end-organ damage to blood vessels, heart and kidneys

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30
Q

name some renal disease that cause secondary hypertension

A

> chronic pyelonephritis
fibromuscular dysplasia
renal artery stenosis
polycystic kidneys

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31
Q

what drugs can cause secondary hypertension?

A

> NSAIDs
oral contraception
corticosteriods

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32
Q

name some endocrine conditions that can cause secondary hypertension

A 
> conn's syndrome
> cushings
> phaeochromocytoma
> hypo/hyper thyroidism
> acromegaly
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33
Q

what vascular problem can lead to high blood pressure?

A

coarctation of the aorta

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34
Q

what causes radial delay?

A

the aorta narrows, and depending where it is there is a difference in time between the radial or femoral pulses as the narrowing slows and weakens the pulse.

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35
Q

what must be used to identify true hypertension?

A

> ambulatory blood pressure monitoring

> home blood pressure monitoring

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36
Q

give some examples of treatable causes of hypertension?

A

> renal artery stenosis
cushings’ disease
Conn’s syndrome
sleep apnoea

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37
Q

what would you do to assess end organ damage?

A 
> ECG
> echocardiogram
> proteinuria
> kidney
> renal function
38
Q

what is the BHS suggested target blood pressure?

A

below 135/85 mmHg

39
Q

why do we treat hypertension?

A

it reduces cerebrovascular disease by 40-50% and MI by 16-30%

40
Q

why is hypertension treated with a stepped approach using several low doses of drugs?

A

to minimise adverse events and maximise patient compliance

41
Q

what sort of drugs are used to treat hypertension in young people?

A

ACE inhibitors/ARB

42
Q

why should ACE inhibitors not be used in young women?

A

due to the risk of pregnancy as they are highly teratogenic

43
Q

what two types of drugs are used to treat hypertension in elderly patients?

A

> calcium channel blockers

> thiazide type diuretics

44
Q

stage one hypertension treatment: antihypertension drug treatmen is offered to people under 80 with ABPM of >135/85 and…….

A 
one or more of the following:
> target organ damage
> established cardiovascular disease
> renal disease
> diabetes
> a 10 year cardiovascular risk equivalent to 20% or greater
45
Q

what should you do if someone is under 40 and has stage 1 hypertension?

A

seek specialist evaluation of secondary causes and a more detailed assessment of potential target organ damage

46
Q

why are patients over 80 treated with the same drug treatment as 55-80 year olds?

A

the medication can lead to falls so if they break something it can lead to a loss of confidence. the larger target pressure benefits from the lower risk of a fall

47
Q

what is the blood pressure target of people over 80?

A

<145/85

48
Q

describe step 1 treatment

A

a calcium-channel blocker is given to people over 55 years and black people of African/Caribbean origin of any age.

49
Q

what should be given in step 1 treatment of hypertension if calcium channel blocker are not suitable?

A

thiazide-like diuretic

50
Q

what is step one treatment for people under 55 years?

A

ACE inhibitor or ARB

51
Q

what is step 2 treatment of hypertension?

A

a thiazide-type diuretic such as clortalidone or indapamide is added

52
Q

what is step 3 treatment of hypertension?

A

add: calcium channel blocker, ACE inhibitor and diuretic together

53
Q

step 4 treatment: if the blood potassium level is 4.5mmol/l or lower what treatment is given?

A

diuretic therapy with low dose spironolactone (25mg once daily)

54
Q

step 4 treatment of hypertension: if the blood potassium is higher than 4.5mmol/l what treatment should be given?

A

higher dose thiazide like diuretic treatment

55
Q

in what people should you use caution when giving low-dose diuretic therapy such as spironolactone?

A

people with reduced GFR due to the increased risk of hyperkalaemia

56
Q

what are the effects of Ramipril and Perindopril?

A

they competitively inhibit the actions of angiotensin converting enzyme (ACE)

57
Q

what is the function of ACE?

A

it converts angiotensin 1 into angiotensin 2

58
Q

name 4 results of organ damage that angiotensin 2 can lead to

A

> stroke
heart failure
myocardial infarction
renal failure

59
Q

what are the negative effects of angiotensin 2 on the kidney?

A

it decreases glomerular filtration rate, decreases proteinuria and increase aldosterone release. it also causes glomerular sclerosis

60
Q

what are the negative effects of angiotensin 2 on the heart?

A

> left ventricular hypertrophy
fibrosis
remodelling
apoptosis

61
Q

state some adverse drug reaction from ACE inhibitors

A 
> cough
> first dose hypotension
> taste disturbance
> renal impairment
> angioneurotic oedema
62
Q

what are the contraindications for ACE inhibitors?

A

> renal artery stenosis
renal failure
hyperkalaemia

63
Q

what drug-drug interactions can occur with ACE inhibitors?

A

> NSAIDs can precipitate acute renal failure
potassium supplements = hyperkalaemia
potassium sparing diuretics = hyperkalaemia

64
Q

name some angiotensin 2 antagonists?

A

losartan
valsartan
candesartan
irbesartan

65
Q

what is the action of angiotensin 2 antagonists?

A

they competitively block the actions of angiotensin 2 at the angiotensin AT1 receptor

66
Q

what is the advantage of using angiotensin 2 antagonists over ACE inhibitors?

A

there is no cough

67
Q

how do calcium channel blocker work?

A

they block the L type calcium channels but are selective between vascular and cardiac channels. they relax the large and small arteries and reduce peripheral resistance. they reduce cardiac output

68
Q

in what patients are vaso-dilating calcium-channel blockers the treatment of choice?

A

> 55 years and in women of child bearing age

69
Q

what are the benefits of vaso-dilating calcium channel blockers?

A

> high compliance
good in elderly patients with systolic hypertension
rarely cause postural hypotension

70
Q

what are the contraindications of vaso-dilating calcium channel blockers?

A

> acute myocardial infarction
heart failure
bradycardia

71
Q

what adverse drug reactions may occur due to vaso-dilating calcium channel blockers?

A 
> flushing
> headache
> ankle oedema
> indigestion
> reflux oesophagitis
72
Q

name some thiazide type diuretics

A

> indapamide

> clortalidone

73
Q

with what other hypertensive drugs can thiazide type diuretic be used with?

A

any other anti-hypertensive drugs

74
Q

in what are thiazide type diuretics a benefit?

A

stroke patients and with myocardial infarctions

75
Q

what is the mechanism of thiazide type diuretics?

A

they block the reabsorption of sodium and enhance sodium urinary loss

76
Q

what ADRs may be caused by thiazide type diuretics?

A

gout and incompetence

77
Q

name some less commonly used agents in hypertensive treatment

A

> alpha-adrenoceptor antagonists
centrally acting agents
vasodilators

78
Q

name an alpha-adrenoceptor antagonist

A

doxazosin

79
Q

name some centrally acting agents

A

methyldopa

maxnidine

80
Q

name some vasodilators

A

hydralazine

minoxidil

81
Q

what is the action of doxazosin?

A

it is an alpha-adrenoceptor antagonist which selectively blocks synaptic alpha 1 adrenoceptors to oppose vascular smooth muscle contraction in arteries

82
Q

what adverse drug reactions are associated with alpha-adrenoceptor antagonists?

A

> first dose hypotension
dizziness
dry mouth
headache

83
Q

what is the action of methyldopa?

A

it is a centrally acting agent that is converted to alpha-methylnoradrenaline which acts on the central nervous system alpha adrenoreceptors decreasing the central sympathetic outflow

84
Q

what are the adverse drug reactions associated with centrally acting agents?

A

sedation and drowsiness
dry mouth and nasal congestion
orthostatic hypotension

85
Q

what is moxonidine?

A

it is a centrally acting imidazoline agonist

86
Q

what drug would you prescribe at a pre-pregnancy clinic?

A 
methyldopa 
nifedipine MR
atenolol
labetalol
NOT ACE inhibitor or ARB
87
Q

what is the risk with hypertension during pregnancy?

A

it is the second most common cause of maternal and fetal death and there is a common risk for pre-eclampsia

88
Q

what is gestational hypertension?

A

this is when the blood pressure rises during pregnancy so the patient develops hypertension but there is no pronteinuria

89
Q

describe the changes that would occur if the patient developed pre-eclampsia

A

BP rises from about 20 weeks >140/90 mmHg and proteinuria is >300mg/24h

90
Q

what is prescribe during pregnancy?

A

a thiazide diuretic and/or amlodipine is added

91
Q

why must labetalol be given in high doses during pre-pregnancy?

A

it has a major first pass metabolism

92
Q

what is pre-eclampsia treated with?

A

the current medication plus intravenous esmolol, labetalol and hydralazine

Cardiovascular system (34 decks)

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