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Medicine Phase 2a CVS > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Why is screening for hypertension important

A

Hypertension is often symptomless

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2
Q

What can result for hypertension

A

Major cause of premature vascular disease, leading to cerebrovascular events, ischaemic heart disease and peripheral vascular disease.
Increased blood pressure means increased mortality rates

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3
Q

Epidemiology of hypertension

A

Men
>35
Major risk factor for CVD
Under treated, under diagnosed and poorly controlled in UK

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4
Q

What is considered normotensive

A

less than 140/90mmHg

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5
Q

What are the stages of hypertension

A

Stage 1 hypertension
Stage 2 hypertension
Severe hypertension

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6
Q

What classifies as Stage 1 hypertension

A

Equal to or >140/90mmHg

Daytime average Ambulatory blood pressure monitoring (ABPM - 24hr BP monitor) or Home blood pressure monitoring (HBPM); Equal to or >135/85mmHg

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7
Q

What classifies as Stage 2 hypertension

A

Equal to or >160/100mmHg clinic BP

Daytime average ABPM or HBPM Equal to or >150/95mmHg

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8
Q

What classifies as Severe hypertension

A

Clinic systolic BP Equal to or >180mmHg and/or
diastolic BP Equal to or >110mmHg
Start immediate anti-hypertensive drug treatment!

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9
Q

What is the most common cause of atherosclerosis and cerebral haemorrhage

A

Hypertension

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10
Q

How can you classify the causes of hypertension

A

Unknown - Essential (primary or idiopathic) hypertension (most cases)
Known - Secondary hypertension

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11
Q

Essential hypertension is multifactorial - give examples of things that can contribute to the disease

A
  • Genetic susceptibility
  • Excessive sympathetic nervous system activity
  • Abnormalities of Na+/K+ membrane transport
  • High salt intake
  • Abnormalities in renin-angiotensin-aldosterone system
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12
Q

Causes of Secondary hypertension

A

Renal disease
Pregnancy
Other potential underlying causes:
Endocrine causes, Coarctation of aorta, Drug therapy

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13
Q

What is most common cause of secondary hypertension

A

Chronic Kidney Disease

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14
Q

What is the most common cause of chronic kidney disease

A

Diabetes

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15
Q

How can renal disease be exacerbated by hypertension

A

Hypertension accelerates atherosclerosis and endothelial cell dysfunction, promoting pheochromocytoma vasoconstriction - this can cause or exacerbate renal disease

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16
Q

Endocrine causes of secondary hypertension

A

Cushings syndrome
Conn’s syndrome
Pheochromocytoma

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17
Q

How does Cushings cause hypertension

A

Hypersecretion of corticosteroids (which enhance adrenalines resulting in a vasoconstrictive effect) is associated with systemic hypertension

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18
Q

How does Conns cause hypertension

A

Adrenal tumour that secretes ALDOSTERONE (resulting in Na+ retention and thus water retention thereby increasing blood volume and pressure) can cause hypertension

19
Q

How does Pheochromocytoma cause hypertension

A

Adrenal tumour that secretes CATECHOLAMINES (resulting in the stimulation of alpha-adrenergic receptors resulting in vasoconstriction, increased cardiac contractility as well as the stimulation of beta-adrenergic receptors resulting in an increase in heart rate and contractility) can cause hypertension

20
Q

Describe presentation of hypertension in coarctation of aorta (systemic hypertension is one of most common features of coarctation)

A

Raised blood pressure will be detected in either arm, but NOT in the legs
The femoral pulse is often delayed relative to the radial

21
Q

Untreated or undiagnosed patients with coarctation of aorta with hypertension can die from..

A

CF
Hypertensive Cerebral Haemorrhage
Dissecting aneurysm

22
Q

Prescription drugs that can cause hypertension

A

Corticosteroids e.g. Prednisolone
Cyclosporin
Erythropoietin
Some types of the contraceptive pill

23
Q

Non-prescription drugs that can cause hypertension

A

Alcohol
Amphetamines
Ecstasy
Cocaine

24
Q

Risk Factors for hypertension

A
  • Age (risk increases as you age)
  • Race - hypertension is more common in blacks
  • Family history (hypertension runs in families)
  • Overweight and obese
  • Little exercise
  • Smoking
  • Too much salt in diet
  • Alcohol
  • Diabetes
  • Stress
25
Q

Hypertension: Vascular Changes

A
  • Hypertension accelerates atherosclerosis
  • Thickening of the media of muscular arteries
  • It is the smaller arteries and arterioles that are especially affected in hypertension
  • *The resulting endothelial cell dysfunction is associated with impaired nitric oxide-mediated vasodilatation and enhanced secretion of vasoconstrictors including endothelins and prostaglandins
26
Q

Hypertension: Heart damage that could result

A

Hypertension is a major risk factor for ischaemic heart disease

27
Q

Hypertension: Nervous system damage that could result

A

Intracerebral haemorrhage is a frequent cause of death in hypertension

28
Q

Hypertension: Kidneys damage that could result

A

Hypertension can cause or result from renal disease
Kidney size reduced
Smaller vessels show intimal thickening and medial hypertrophy
Numbers of sclerotic glomeruli are increased

29
Q

Describe Malignant hypertension in body

A

Markedly raised diastolic blood pressure, usually over 120mmHg and progressive renal disease.
Renal vascular changes
Acute haemorrhage
Papilloedema (optic disc swelling due to raised inter cranial pressure)

30
Q

Who can get malignant hypertension

A

Can occur in previously fit individuals

Often black males in their 30-40s

31
Q

Consequences of malignant hypertension

A
  • Cardiac failure with left ventricular hypertrophy and dilatation
  • Blurred vision due to papilloedema and retinal haemorrhages
  • Haematuria and renal failure due to fibrinoid necrosis of glomeruli
  • Severe headache and cerebral haemorrhage
32
Q

Clinical presentation of hypertension

A 
Usually asymptomatic (except malignant hypertension)
Found on screening
33
Q

Diagnosis of hypertension

A

End-organ damage e.g. left ventricular hypertrophy, retinopathy and proteinuria (indicates severity and duration of hypertension and associated with a poorer prognosis)

Urinalysis: protein/albumin:creatine ratio and haematuria

Blood tests

Fundoscopy/Opthalmscopy (looking for retinal haemorrhage or papilloedema)

Echocardiography or ECG: LV hypertrophy

24 hour ambulatory BP monitoring

34
Q

What would you look for on blood tests of hypertension

A

Serum creatinine
eGFR
Glucose (to assess diabetes risk)

35
Q

What is the goal BP from treatment of hypertension

A

140/90mmHg

36
Q

Non- drug treatment of hypertension

A 
Change diet: High consumption of vegetable and fruits and low-fat diet
Regular physical exercise
Reduce alcohol intake
Reduce salt intake
Lose weight
Stop smoking
37
Q

Pharmacological treatment of hypertension

A

ACD pathway:
A - ACE-inhibitor e.g. Ramipril or Enalapril
C - Calcium channel blocker (CCB) e.g. Nifedipine or Amlodipine
D - Diuretics e.g. Bendroflumethiazide (thiazide, distal tube - less potent) or Furosemide (loop diuretic, loop of henle - more potent)

38
Q

If patient has coughing issues, what would you give instead of the contra-indicated ACE-inhibitor for treating hypertension

A

Angiotensin Receptor Blocker (ARB) e.g. Candesartan or Losartan

39
Q

When would you consider Beta-blocker as treatment for hypertension

A

Not first line treatment
Consider in young people especially if intolerant to ACEi/ARB
In people where higher dose of drugs not tolerated

40
Q

What drugs would you give to patients <55 yrs old to treat their hypertension

A 
Ramipril/Candesartan
\+ Nifedipine
\+ Bendroflumethiazide
\+ Furosemide
(in stages?)
41
Q

What drugs would you give to patients >55 yrs old/black/African-Carribean origin to treat their hypertension

A

Ramipril/Candesartan + Nifedipine
+ Bendroflumethiazide
+ Furosemide
(3 stages)

42
Q

What is essential hypertension

A

Hypertension with primary cause unknown

43
Q

How does size of kidney change with hypertension

A

Reduces

44
Q

*Investigations and their results

A

Urinalysis - protein; albumin:creatinine ratio; haematuria
Blood tests - serum creatinine
Fundoscopy/ophthalmoscopy - papilloedema
ECG - LV hypertrophy

Medicine Phase 2a CVS (17 decks)

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