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4 Finals > Hypertension > Flashcards

Hypertension Flashcards

(45 cards)

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1
Q

What is considered optimal blood pressure?

A

<120/75mmHg

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2
Q

What is considered normal blood pressure?

A

120-129/75-84mmHg

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3
Q

What is considered high normal blood pressure?

A

130-139/85-89mmHg

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4
Q

What is considered mildly high blood pressure?

A

140-159/90-99mmHg

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5
Q

What is considered moderately high blood pressure?

A

160-179/100-109mmHg

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6
Q

What is considered severely high blood pressure?

A

> 180/110mmHg

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7
Q

What is the definition of hypertension?

A

BP of >140/90 without an identifiable cause

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8
Q

What are the possible causes of hypertension?

A 
Disturbance of auto-regulation
Excess sodium intake
Renal sodium retention
Dysregulation of RAAS with high Renin activity in plasma
Increased sympathetic drive
Increased peripheral resistance
Endothelial dysfunction
Cell membrean transporter perturbations
Insulin resistance/hyperinsulinaemia
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9
Q

What is involved in the pathophysiology of hypertension?

A

Structural changes, remodelling and hypertrophy in resistance arterioles
Small vessel atherosclerosis

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10
Q

What are the recommended lifestyle modifications in hypertension?

A

Dietary
Smoking cessation
Increased activity
Reduced alcohol

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11
Q

When should people be screened for hypertension?

A

Every 2 years

If high normal BP then every year

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12
Q

What are the common diagnostic factors in hypertension?

A

Presence of risk factors
BP >140/90
Retinopathy

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13
Q

What are the uncommon diagnostic factors in hypertension?

A 
Headache
Visual changes
Dyspnoea
Chest pain
Sensory/motor deficit
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14
Q

What are the strong risk factors for hypertension?

A 
Obesity
<3days/week aerobic exercise
Mod-high alcohol intake
Metabolic syndrome
DM
Black
Age >60
FH HTN/CAD
Sleep apnoea
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15
Q

What are the weak risk factors for hypertension?

A

Sodium intake >2.4g/day
Low fruit and veg intake
Dyslipidaemia

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16
Q

What are the investigations recommended for hypertension?

A

ECG
Fasting metabolic panel with eGFR
Fasting lipid panel
Urinalysis

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17
Q

What other investigations may be considered in hypertension?

A 
Hb
Plasma renin
Plasma aldosterone
Renal duplex USS
24-h urine phaeochromocytoma screen
24-h urine free cortisol
TSH
Sleep study
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18
Q

What is the DDx of hypertension?

A 
Drug-induced
CKD
Aortic coartation
Renal artery stenosis
Obstructive sleep apnoea
Hyperaldosteronism
Hypothyroidism
Hyperthyroidism
Hyperparathyroidism
Cushings syndrome
Phaeochromocytoma
Acromegaly
Collagen vascular disease
Gestatonal HTN
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19
Q

3 main objectives in the diagnostic approach to hypertension are?

Study These Flashcards
A

Assess risk factors
Reveal identifiable causes
Detect target-organ damage incl CVD

20
Q

What things should be examined when assessing a patient with new hypertension?

Study These Flashcards
A 
BP
Optic fundi
BMI
Carotid, abdo, femoral bruits
Palpation of thyroid
Examination of heart and lungs
Abdo exam
Palpation of lower extremities for oedema and pulses
Neuro assessment
21
Q

What features on examination would indicate evidence of end-organ damage from hypertension?

Study These Flashcards
A 
Retinopathy
Vascular bruits
Signs of CHF
Evidence of AA
LVH
Absence of femoral pulses
Abdominal bruits
Secondary HTN
22
Q

If a patient is white/Asian and <55 what is the 1st line treatment for hypertension?

23
Q

If a patient is black or >55 what is the 1st line treatment for hypertension?

Study These Flashcards
A

CCB or thiazide diuretic

24
Q

What is second line therapy in hypertension?

Study These Flashcards
A

ACEI/ARB + CCB or ACEI/ARB + thiazide diuretic

25
What is 3rd line therapy in hypertension?
ACEI/ARB + CCB + diuretic
26
What is 4th line therapy in hypertension?
``` ACEI/ARB + CCB + thiazide diuretic PLUS - further diuretic - alpha-blocker - beta-blocker ```
27
What is 1st line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99)
Beta Blocker | + lifestyle modification
28
What is 2nd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99)
CCB
29
What is 1st line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)
Beta blocker + CCB
30
What is 2nd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)
beta blocker + ACEI/ARB
31
What is 3rd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)
Beta blocker + thiazide diuretic OR ACEI/ARB + thiazide diuretic
32
What is 1st line therapy in an individual with hypertension, with concomitant CHF with ejection fraction <40%?
``` ACEI/ARB + beta-blocker PLUS - diuretic - aldosterone agonists - isosorbide dinitrate/hydralazine ```
33
What is 1st line therapy in an individual with hypertension, with concomitant LVH without CAD?
ARB/ACEI
34
What is 1st line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN?
ACEI/ARB
35
What is 2nd line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN?
CCB OR Thiazide diuretic
36
What is 1st line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN not at goal with monotherapy or stage 2 HTN?
ACEI/ARB + thiazide diuretic
37
What is 2nd line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN not at goal with monotherapy or stage 2 HTN?
ACEI/ARB + CCB
38
What is 1st line therapy in an individual with hypertension, with concomitant AF without other comorbidity?
Beta blocker
39
What is 2nd line therapy in an individual with hypertension, with concomitant AF without other comorbidity?
CCB
40
What is 1st line therapy in an individual with hypertension, with refractory/resistant hypertension at any stage, without CHF?
Individualised therapy
41
What is 1st line therapy for a pregnant woman <37 weeks gestation with mild-mod hypertension?
Lifestyle modification | Delivery if increased risk
42
What is 2nd line therapy for a pregnant woman <37 weeks gestation with mild-mod hypertension?
Antihypertensives (methyldopa/labetalol/nifedipine) | Delivery if increased risk
43
What is 1st line therapy for a pregnant woman <37 weeks gestation with severe hypertension?
Antihypertensives (methyldopa/labetalol/nifedipine)
44
What is 1st line therapy for a pregnant woman >37 weeks gestation with mild-mod hypertension?
Induction of labour/delivery
45
What is 1st line therapy for a pregnant woman >37 weeks gestation with severe hypertension?
Antihypertensives (methyldopa/labetalol/nifedipine) + Induction of labour/delivery

4 Finals (20 decks)

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