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Cardiovascular System > Hypertension > Flashcards

Hypertension Flashcards

(91 cards)

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1
Q

Brain complications

A

Haemorrhage
Stroke
Cognitive decline

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2
Q

Eye complications

A

Retinopathy

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3
Q

Blood vessel complications

A

Peripheral vascular disease

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4
Q

Heart complications

A

Left ventricular hypertrophy
Coronary Heart Disease
Congestive Heart Failure

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5
Q

Renal Complications

A

Renal Failure
Dialysis
Transplantation
Proteinuria

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6
Q

Framingham Study

A

Increase in blood pressure is associated with progressive increase in the risk of stroke and CV disease

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7
Q

At what blood pressure is a patient hypertensive

A

Diastolic pressure is normal (less than 80 mmHg)

Systolic pressure is high (greater or equal to 130 mmHg)

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8
Q

ABPM

A

Ambulatory Blood Pressure Monitoring- when your BP is measured as you move around living your normal life

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9
Q

Stage 1 Hypertension

A

Clinic BP 140/90 or higher

ABPM 135/80 mmHg or higher

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10
Q

Stage 2 Hypertension

A

Clinic BP 160/100 mmHg or higher

ABPM is 125/95 mmHg or higher

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11
Q

Severe Hypertension

A

Clinic systolic pressure is 180 mmHg or higher or diastolic pressure is 110 mmHg or higher

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12
Q

5-10% of cases of secondary hypertension is caused by (7)

A 
Chronic renal disease
Renal artery stenosis
Endocrine disease
Cushing's
Vonn's Syndrome
Pheochromocytoma
GRA
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13
Q

Risk of morbidity from hypertension increases exponentially with what factors (7)

A 
Smoking
Diabetes Mellitus
Hyperlipidaemia
Renal disease
Male
Previous MI or stroke
Left ventricular hypertrophy
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14
Q

Prime contributors to blood pressure

A

Cardiac output

Peripheral vascular resistance

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15
Q

Sympathetic system activation produces

A

Vasoconstriction
Reflex tachycardia
Increased cardiac output

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16
Q

The Renin-Angiotensin-Aldosterone System is responsible for (4)

A

Long-term BP control
Sodium balance
Control of blood volume
Control of blood pressure

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17
Q

RAAS is stimulated by (3)

A

Fall in BP
Fall in circulating volume
Sodium depletion

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18
Q

Where is renin released from

A

Juxtaglomerular apparatus

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19
Q

What is the function of Renin

A

Converts angiotensin to angiotensin I

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20
Q

What converts angiotensin I to angiotensin II

A

ACE

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21
Q

Function of Angiotensin II (3)

A

Vasoconstrictor
Anti-natriuretic peptide
Stimulator of aldosterone release from the adrenal glands

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22
Q

What stimulates the release of aldosterone and where from

A

Angiotensin II

Adrenal glands

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23
Q

Function of Aldosterone

A

Anti-natriuretic

Anti-diuretic peptide

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24
Q

Angiotensin stimulates what

A

Potent hypertrophic agent and stimulates myocyte and smooth muscle hypertrophy in the arterioles

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25
Key targets in the treatment of hypertension
Sympathetic system | RAAS
26
Why may the risk of hypertension increase with age?
Decreased arterial compliance
27
The closest correlation exists between siblings or parent and child
Siblings
28
Does hypertension run in families (Y/N)
Yes
29
How many genes account for how much mmHg
>30 | 0.5 mmHg
30
Low levels of daily potassium consumption
High systolic pressure
31
The lower the birth rate the__
higher the likelihood of developing hypertension and heart disease
32
Why are black populations more sensitive to an increase in dietary salt intake
Genetically selected to be salt retainers
33
Causes of Secondary Hypertension (6)
``` Renal disease Drug induced Pregnancy Endocrine Vascular- coarctation of the aorta Sleep apnoea ```
34
Renal disease
– chronic pyelonephritis – fibromuscular dysplasia – renal artery stenosis – polycystic kidneys
35
Drugs linked to secondary hypertension
– NSAIDs – Oral contraceptive – Corticosteroids
36
Endocrine diseases related to hypertension (5)
``` – Conn’s Syndrome – Cushings disease – Phaeochromocytoma – Hypo and hyperthyroidism – Acromegaly ```
37
True hypertension
Must use ABPM or HBPM
38
Treatment of hypertension (5)
1. Identify true hypertension 2. Assess risk 3. Asses end organ damage 4. Screen for treatable causes 5. Stepped approach
39
Treatment for young (high renin)
ACE Inhibitor/ARB
40
Treatment for elderly (low renin) (2)
CCB | Thiazide-type diuretic
41
Aged under 40 with stage 1
Specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage
42
White coat effect
When your blood pressure is higher in a medical setting
43
How would you overcome the white coat effect
consider ABPM or HBPM as an adjunct
44
Anti-hypertensive treatment with CCB
People aged over 55 | People of african or caribbean descent
45
Treatment with ACEI/ARB (3)
Young people | Not of caribbean descent or of child bearing age
46
If single agent doesn't work what can you do
CCB and ACEI/ARB
47
CCB is not suitable for
Patients with oedema, intolerance | Evidence of Heart Failure
48
What can be offered as an alternative to CCB
Thiazide-like diuretic
49
Examples of thiazide-like diuretic (2)
Chlortalidone | Indapamide
50
Treatment for resistant hypertension
Further diuretic therapy with low-dose spironolactone if the potassium levels are 4.5 mmol.l or lower
51
ACEIs
Ramipril
52
Contraindication of ACEIs (3)
Renal artery stenosis Renal failure Hyperkalemia
53
Adverse drug reactions of ACEIs (5)
* Cough * First dose hypotension * Taste disturbance * Renal Impairment * Angiogenic oedema
54
NSAIDs and ACEIs
Precipitate acute renal failure
55
Potassium supplements and ACEIs
Hyperkalaemia
56
Potassium sparing diuretics
Hyperkalaemia
57
ARB examples
Losartan Valsartan Candesartan Irbesartan
58
Mechanism of ARB
competitively block the actions of angiotensin II at the angiotensin AT1 receptor
59
What is the advantage of ARB over ACEI
No cough
60
What is Atenolol
Beta blocker
61
What is Enalpril
ACEI
62
Vasodilator CCB
• Amlodipine/Felodipine
63
Rate-limiting CCB
Verapamil/Diltiazem
64
How do CCB work (4)
- Blocking the L type calcium channels - Selectivity between vascular and cardiac L type channels - Relaxing large and small arteries and reducing peripheral resistance - Reducing CO
65
Vasodilating CCBs are the best choice with what type of patients (2)
– over 55years. | – women of child bearing age
66
Contraindications of CCBs (3)
Acute MI | Heart failure, bradycardia
67
Adverse drug reactions of CCB (5)
``` – Headache – Ankle oedema – Indigestion and reflux oesophagitis - Bradycardia - Constipation ```
68
Examples of Thiazide-type diuretics
* Indapamide | * Chlortalidone
69
Alpha-adrenoreceptor antagonists examples
Doxazosin
70
Mechanism of alpha-adrenoreceptor antagonists (2)
– Selectively block post-synaptic alpha 1 adrenoreceptors | – Oppose vascular smooth muscle contraction in arteries
71
Adverse drug reactions of alpha-adrenoreceptor antagonists (4)
Hypotension Dizziness Dry mouth Headache
72
Example of centrally acting agents
Methylodopa | Moxonidine
73
Mechanism of methyldopa
used in hypertension within pregnancy | Converted to a-methylnoradrenaline and decreases sympathetic outflow
74
Mechanism of Moxonidine
Centrally acting Imidazoline agonist
75
Pre pregnancy hypertension treatment
– Nifedipine MR, Methyl dopa, Atenolol, Labetalol
76
During pregnancy hypertension treatment
– Add thiazide diuretic and/or amlodipine
77
What is preeclampsia and how is it treated
High blood pressure during pregnancy | IV hydralazine, esmolol, labetalol
78
Stage 1 hypertension in children
BPs from the 95th-99th percentile plus 5mmHg
79
Stage 2 hypertension in children
BP above 99th percentile plus 5mmHg
80
Childhood hypertension is associated with (6)
LVH • Decreased vascular responsiveness • Increased carotid artery intimal medial thickness • Increased atheroma deposition • Reduced cognitive scored in hypertensive children reduced GFR
81
Commonest cause of hypertension in newborn infants (4)
– Renal artery thrombosis – Renal artery stenosis – Congenital renal malformations – Coarctation
82
Commonest cause of hypertension in infants-6 years (3)
– Renal parenchymal disease – Coarctation – Renal artery stenosis
83
Commonest cause of hypertension in 6-10 years (3)
– Renal parenchymal disease – Renal artery stenosis – Primary hypertension (diet, obesity, lifestyle)
84
Commonest cause of hypertension 10-18 years (2)
– Primary hypertension (diet, obesity, lifestyle) | – Renal parenchymal disease
85
Causes of accelerated hypertension
Lack of primary care and healthcare Non-adherence to medication Ilicit drug use
86
Malignant Hypertension
cases where papilloedema grade IV fundal changes
87
Hypertensive Urgency
• Severe hypertension with no evidence of target organ damage. "urgency" rather than “emergency”
88
How is a hypertensive urgency manages
continuous infusion of a short acting, titratable antihypertensive agent.
89
Hypertensive emergencies treatment
reducing mean arterial pressure by <25% for the first hour and then to 160/100-110 mmHg by 2-6 hours with subsequent gradual normalisation over 24-48 hours
90
Goal of accelerated hypertension treatment
reduce DBP by 15-20% or to about 110mmHg over a period of 30-60 minutes • Set a 2 hour and 6-hour BP target to be achieved • Once stabilised with IV agents oral therapy can be initiated and the IV agents slowly titrated down
91
What does excessive correction of the BP cause
Further reduces organ perfusion and produce multiorgan infarction

Cardiovascular System (42 decks)

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