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hypertension Flashcards

(65 cards)

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1
Q

what does a 2mmHg rise in blood pressure lead to

A

7% - increase risk of mortality for IHD (ischemic heart disease)

10% - increase risk mortality from stroke

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2
Q

what is special about the treatment of hypertension

A

it is the most cost effective treatment ever reviewed

roughly £30 per year

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3
Q

what are the complications of hypertension on organs (late stage)

A

brain - stroke, haemorage, cognitive decline

retinopathy - eye damage

reanaly failure, dialysis

peripherial vascular disease

heart - Left ventrical failure, coronary heart disease, congestive heart failure, MI

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4
Q

what is the definition of hypertension

A

That blood pressure above which the benefits of treatment outweigh the risks in term of morbidity and mortality

very personal per person

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5
Q

what is the rough guide for when a patient is hypertensive

A

140/90

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6
Q

what is the optimum - why is this important

A

<120/<80

this should be the target for young people

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7
Q

what is stage 1 hypertension

A

clinic reading 140/90

ambulatory blood pressure monitoring - 135/85

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8
Q

what is stage 2 hypertension

A

clinic reading 160/100

ABPM - 150/95

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9
Q

what is severe hypertension

A

when systolic pressure is 180 or higher

when diastolic is 100 or higher

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10
Q

what is primary hypertension - what percentage of cases is this

A

hypertension that doesn’t have a secondary cause

90% of cases

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11
Q

what are the casues of 2econdary hypertension - percentage

A

5-10% of cases secondary hypertension

chronic renal disease
renal artery stenosis
endocrinde disease
cushings
conns syndrome
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12
Q

how many deaths does hypertension cause

A

no 1 killer

> 20% of deaths are directly/indirectly related

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13
Q

why do people who have hypertension and are under 40 see a specalits

A

as there is often a underlying cause

and its a secondary hypertension diagnosis

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14
Q

what factors increase the likely hood of hypertension

A 
ciggaret smoke 
diabetes mellitus 
renal disease
male 
hyperlididaemis 
previous MI or stroke 
Left ventricular Hypertrophy 
fitness
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15
Q

what is diabetes mellitus

A

a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.

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16
Q

what factors contribute to blood pressure

A

CO - cardiac out put
SV - stroke volume
HR - heart rate
TPR - total peripheral resistance

drugs can target each of these factors

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17
Q

what accounts for second to second blood pressure changes

A

sympathetic system

  • vasocontstiction
  • reflex tachycardia
  • increased cardiac output
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18
Q

what is pivotal in long term blood pressure control

A

the renin-angiotensisn-aldosterone system

RAAS

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19
Q

what is the retin-angiotension-aldosterone system responsible form

A

mananing Na balance

control of blood volume

controll of blood pressure

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20
Q

what is the RAAS stimulated by

A

fall in BP

fall in circulating volume

sodium depletion

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21
Q

what happens once the RAAS system is stimulated

A

renin is released from the juxtaglomerular apparatus (kindey bulitding blocks)

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22
Q

what is the function of renin

A

to conver angiotensinogen to angiotensin 1

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23
Q

what does angiotensin 1 do

A

it is converted into angiotensisn 2 converting enzyme (ACE - ahhhhhhh!)

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24
Q

what is angiotensin 2

A

its a potent vasoconstrictor

anti-naturiuretic peptide (reduces overfilled ECF volume by increasing renal sodium excretion)

simulator of aldosterone release form the adrenal glands

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25
when the RAAS is stimulated what does this mean
that there is a drop in BP
26
how does angiotensin 2 effect the arterioles
its a potent hypertophic agent (makes cells big) which stimulates myocyte and smoothe muscle hypertrophy in the arterioles
27
what is the function of aldosterone
its a potent anti-naturutetic and anti-deretic (retain water)
28
what are myocyte and smooth muscle hypertrophy
poor prognostic indicators in hypertensive patients explains the risks from hypertension stay after treatment
29
the aetiology of hypertension is examples?
polygenic - genes (GRA, angiotensinogen) - poly genes (race, obesity) polyfactorial - oral contraceptives - stress - lower education
30
what other factors effect hypertension
``` age faliy genetics environment weight alchol race ```
31
what should the treatment of hypertension generally be
AGRESSIVE but be pragmatic - if the elderly cant withstand the treatment don't give it to them
32
what is the best link between family membrers to suggest genetics plays a factor in BP
the cosest correlation exists between siblings rather than parent to child
33
what effects does alcholo have on BP
small amounts = lowers BP largere amounts = rasies BP
34
what is 30% of hypertension attributed to
obesity - more likely to have sleep aponea - cause hypertension
35
what factors does bith weight have on hypertension
the lower the birth weigh the greater chance of hypertension
36
what effects does race have on BP
caucasioan have a lower BP than black populations living in the same environments
37
what drugs can induce secondary hypertension
NSAIDS - nonsteroidal antiinflammatory drugs oral contraceptions cortocsteroids
38
what pregnancy related illness can cause hypertension
pre-eclampsia
39
what aortic defect can lead to hypertension
coarctation of the aorta
40
what are the steps in diagnosis of hypertension
identify true hypertension = using ambulatory blood pressure monitor assess risk asses end organ damage screen for treatable causes
41
what are the steps of treatment
set target - <135/80-85 mmHg (depends om patient should be lower for younger patients)
42
how do we treat hypertension
stepped approach use low doses of several drugs - minimuses adverse effects slow reduction to stop fainting and other problems
43
what should you treat the elderly (low renin) with
calcium channel blocker then thiazide-like diuretic if there is heart failure, oedema, intolerance
44
what should you treat young individuals (high renin) with
ACE inhibitors/ ARB
45
what peple should treatment not be offered to if they have stage 1 hypertension
people over the age of 80 - they are doing just fine
46
how should not get ACE inhibitors
afro-caribean people females of child bearing age (could lead to tertarogenisi)
47
if the ACE inhibitor/ARB or CCB is not getting the desired effect what should you do - then whaty
add thiazide-like diuretic if that dosent help add all 3 together
48
2 examples of thiazide-like diuretic
chlortalidone indapamide
49
what should be used for resistant hypertension
low dose spironolactone (careful about K) higher dose thiazide-like diuretic
50
what is an example of a ACE inhibitor
Ramipril
51
when should ACE inhibitors not be used
Renal artery stenosis Renal failure Hyperkalaemia
52
what are ARBs
angiotensin 2 antagonists
53
what are some examples of ARBs
losartan , valsartan
54
vasodilating CCBs are the hypertensive of choice in which populations
people over 55 years old women of child bearing age
55
what are examples of vasodilationg CCBs
amlodipine/felodipine
56
what are exampels of rate limiting CCBs
verapamil diltiazem
57
how do CCBs work
blocking the L type calcium channels reducing TPR by relaxing arteries reducing CO
58
when should CCBs not be used
acute MI heart failure, bradycardia (rate limiting CCBs)
59
what side effects occur due to rate limiting CCBs
bradycardia | constibation
60
what are exampels of thiazide type diuretics
INDAPAMIDE clortalidone
61
when are thiazide type diuretics used
the first line treatment in mild-moderate hypertension in Afro-Caribbean in combination with anyother antihypertensive
62
what is important to know aboyt thiazide type diuretics
antihypertensive effect may take weeks
63
if a women is of child bearing age what should be prescribed
CCB or beta blocker
64
what is hypertension in relation to pregnancy
the second most common cause of fetal and maternal death
65
what is the treatmen for pregnant woment
PRE PREGNANCY atenolol (beta blocker) then during pregnancy add thiazide diuretic

cardiovascular (26 decks)

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