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Cardiorespiratory CC > Hypertension > Flashcards

Hypertension Flashcards

1
Q

BP determined by:

A

Rate of blood flow produced by heart (CO)

Resistance of blood vessels to blood flow

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2
Q

BP equation

A

BP= CO x SVR

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3
Q

Systolic BP

A

the maximum BP during ventricular contraction

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4
Q

Diastolic BP

A

the minimum level of BP measured between contractions of the heart

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5
Q

High normal BP (prehypertension)

A

Systolic 130-139

Diastolic 85-89

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6
Q

Hypotension

A

Systolic BP <90mmHg

Diastolic BP <60mmHg

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7
Q

Postural hypotension

A

Present if SBP decrease in standing >20mmH or DBP >10mmHg

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8
Q

Hypertension

A

Persistent systolic >140mmHg, diastolic >90mmHg

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9
Q

Hypertension epidemiology

A

16 million ppl in UK
30% W, 32% M
Generally increases with age

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10
Q

Framingham Study

A

6x increase in stroke
3x increase cardiac death
2x likelihood peripheral arterial disease
CV mortality risk proportional to increase in BP

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11
Q

Adults 40-69

A

Each 20/10mmHg increase in BP doubles risk of mortality from stroke, ischaemic HR + other vascular causes

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12
Q

Hypertension optimal treatment trial (HOTT)

A

Largest interventional trial in hypertension
Lowest incidence of major CV events occurred at an achieved Diastolic BP of 83mmHg
Diabetics: Diastolic BP < 80mmHg gives 51% lower risk of CHD compared to >90mmHg

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13
Q

Concentric hypertrophy

A

Stroke volume decreased

Tachycardia necessary for normal CO

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14
Q

Vascular disease deaths

A

same as cancer

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15
Q

Eccentric hypertrophy

A

Lower SP
reduces DV
often leads to HF

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16
Q

Hypertensive retinopathy

A

Chronic hypertension damaging retinal BVs

17
Q

Signs of damage to retinal vessels

A 
Silver or Copper wire arterioles
Retinopathy lesions (microaneurysms, blot+flame haemorrhages, cotton wool spots, swelling of optic disc)
18
Q

Silver or Copper wire arterioles

A

Centre of the arteriole shines due to reflected light

19
Q

Hearing loss

A

Combination of hypertension + diabetes is a major risk factor

20
Q

Primary Hypertension

A

90-95%
No obvious underlying cause
Strong polygenic familial trend

21
Q

Secondary Hypertension

A

5%
Clear underlying cause including- renal/renovascular disease, endocrine disease, coarctation of aorta, iatrogenic, thyroid

22
Q

Endocrine disease- 2ndary hypertension

A

Phaeochomocytoma (tumour of chromaffin cells)
Cushings syndrome (adrenal cortical tumour)
Conn’s syndrome (hypersecretion of aldosterone)
Acromegaly + hypothyroidism

23
Q

Chronic hypertension

A

Associated mainly with pathology in renin-angiotensin system

24
Q

BP control factors

A

Baroreceptors in carotid artery

Renin-angiotensin aldosterone system

25
Q

Possible Hypertension causes

A

Impaired NO production (decreased)
Elevated renin release
Reduced atrial natriuretic peptide release

26
Q

NO function

A

Gas diffuses into underlying smooth muscle + relaxes it

Balances vasoconstrictor effects of angiotensin + noradrenaline

27
Q

Atrial natriuretic peptide

A

Released from heart muscle cells in atrial wall if increased atrial BV
Reduces the ECF vol. by increasing sodium excretion
Dilates glomerular afferent arterioles, constricts efferent arterioles, relaxes mesangial cells
Increases GFR –> increase in water excretion

28
Q

Hypertension + diabetes

A

Hypertension present in about 40% of patients with Type II diabetes at age 45–> rises to 60% age 75

29
Q

Obesity + primary hypertension

A

high levels of leptin increase vasoconstriction- may increase peripheral resistance
Associated with hyperinsulinaemia + insulin resistance–> increases BP, damages endothelial walls, decreases NO + ANP production

30
Q

Metabolic syndrome

A

Central obesity, hypertension + insulin resistance

Increase risk of stroke + serious vascular disease

31
Q

Treatment Under 55

A

ACE or ARB

32
Q

Treatment over 55 or African or Caribeean

A

Calcium channel blocker

33
Q

Treatment diuretic

A

Thiazide-like diuretic
e.g. chlortalidone or indapamide
Conventional thiazide
e.g. Bendroflumethiazide or hydrochlorothiazide

34
Q

BB as treatment

A

ACE inhibitor intolerance
Women of child bearing potential
Ppl with increased sympathetic drive

35
Q

STEP 2 treatment

A

CCB with ACE inhibitor or AB

36
Q

Step 3 treatment

A

3 drug combination of ACE inhibitor/ARB, CCB + thiazide like diuretic

37
Q

Step 4

A

ACE inhibitor/ARB, CCB + diuretic classed as resistant hypertention

Cardiorespiratory CC (34 decks)

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