Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiorespiratory 2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what is the basic cut of for hypertension when you start doing things for you patient

A

140/90 is the basic cut off for hypertension to start doing something for you patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the numbers for prehypertension

A

Systolic: 130-139 , Diastolic:85-89

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

if someone has prehypertension what should be recommended

A
  • lifestyle modification as they have an increased risk of becoming hypertensive
    • NOT candidates for drug therapy (unless compelling indications ie diabetes etc goal <130/80)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the definition of systolic hypertension

A

• Systolic BP > 140 mm Hg, and a diastolic < 90 mm Hg

- this is when the systolic is high and the diastolic is normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do you treat systolic hypertension

A
  • Lifestyle interventions are the first stage of successful treatment,
  • Drugs treatment is recommended if lifestyle changes are not effective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the definition of hypotension

A

Hypotension is generally considered to exist if systolic blood pressure (SBP) is less than 90 mm Hg or diastolic (DBP) less than 60 mm Hg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is postural hypotension

A

this is when you stand up and…

  • your systolic blood pressure decreases by more than 20mmHg
  • and/or your diastolic blood pressure decreases by more than 10mmHg
  • it is associated with dizziness and fainting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

who is hypertension more frequent in

A

More frequent in older patients especially those with diabetes
- can be caused by drugs as well such as antihypertensives (diuretics and vasodilators)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the symptoms that occurs with hypotension

A

CNS effects
1. Dizziness
2. Impaired cognition (especially in elderly)
3. Lethargy, Fatigue
4. Visual disturbances (blurred vision, tunnel vision, ‘greying out’ colour deficits) all due to hypoperfusion of brain
Muscle Effects
1. Paracervical (upper back) ache
2. General fatigue
Heart Effects
- Angina (due to hypoperfusion of heart, especially during exercise)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how do you diagnose hypertension

A
  • repeated measurements on separate occasions days or weeks apart
  • patients must be properly positioned and seated quietly for at least 5 minutes in a chair
  • caffeine, exercise, and smoking should be avoided for at least 30 minutes before a BP measurement
  • use appropriate size cuff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

name the blood pressure sounds

A

1st sound Systolic BP ; Disappearance of sound is Diastolic BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the danger of high blood pressure

A
  • High blood pressure rarely has any symptoms, the only way for people to know if they have the condition is to have their blood pressure measured
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why are age and hypertension connected

A
  • Systolic blood pressure generally increases with age (loss of compliance of arteries is a major factor)
  • Increases with age due to replacement of elastin with fibrinogen or collagen thus they are less stretchy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the types of hypertension

A

primary

secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is primary hypertension

A

90-95% of cases – also termed “essential” of “idiopathic” no obvious underlying cause; Strong polygenic familial trend;

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is secondary hypertension

A

• – about 5% of cases: clear underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is more common primary or secondary hypertension

A

primary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what can cause secondary hypertension

A

– Renal or renovascular disease

– Endocrine disease
• Phaeochomocytoma (tumour of chromaffin cells)
• Cushings syndrome (adrenal cortical tumour)
• Conn’s syndrome (hypersecretion of aldosterone)
• Acromegaly and hypothyroidism

– Coarctation of the aorta

– Iatrogenic
• Hormonal / oral contraceptive
• NSAIDs

  • Thyroid (either HYPER or HYPO) or parathyroid disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what did the framingham study identify

A

it identified the risk of hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what were the 3 main problems that the framingham study identified as risks in hypertension

A
  1. Hypertensives* had a six fold increase in stroke (both haemorrhagic and atherothrombotic) compared with normotensives.
  2. they had a threefold increase in cardiac-related death (due either to coronary events or to cardiac failure).
  3. peripheral arterial disease was as twice as common in hypertensives.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what happens when there is high diastolic pressure

A
  • High diastolic pressure (in the aorta) means the heart has to work harder to open the aortic valve and eject blood into the aorta.
  • Initially this reduces stroke volume and cardiac output;
  • the body responds by increasing sympathetic drive to the heart and increases rate to overcome the reduced stroke volume.
  • this causes Tachycardia
  • Over time, the heart muscle thickens and strengthens to produce a higher end systolic pressure to overcome the high diastolic aortic pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the problem with the thickening of the heart wall

A
  • it can decrease the ventricular volume so stroke volume is not increased or decreased
  • this is concentric hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is concentric hypertrophy

A
  • this is when the wall is thickened and the lumen diameter is decreased
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why does concentric hypertrophy occur

A
  • the myocardial fibres have undergone hypertrophy to increase the pressure during systole in order to overcome a raised end diastolic pressure in the aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what happens to the heart in concentric hypertrophy

A
  • In concentric hypertrophy the stroke volume is decreased, meaning that tachycardia is necessary for normal cardiac output
  • . Also the hypertrophic cardiac muscle often has a poor blood supply; this can lead to ischaemic damage,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What happens in eccentric hypertrophy

A
  • In eccentric hypertrophy the whole ventricle enlarges (and the wall may or may not increase in thickness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what causes eccentric hypertrophy

A
  • caused by conditions that cause increase in preload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does eccentric hypertrophy lead to heart failure

A
  • The enlarged heart produces a weaker force of contraction (due to Laplace’s Law) and this weakened contraction reduces stroke volume with a large residual volume.
  • This tends to make the heart even larger. Thus as the heart gets larger it gets weaker and weaker often leading to heart failure
  • positive feedback loop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what does anaerobic exercise do to the heart in terms of concentric or eccentric remodelling

A
  • Anaerobic (resistance) exercise regimes (eg weight lifting) raise blood pressure by compressing vessels in contracting muscles.
  • This results in cardiac remodelling and a form of concentric hypertrophy.
  • However, in athletes this does not usually reduce ventricular volume. The heart remains healthy.
30
Q

what does aerobic exercise do to the heart in terms of concentric or eccentric remodelling

A
  • Aerobic training increases volume return to the heart (preload).
  • This can produce healthy eccentric remodelling as the heart gradually increases in size to accommodate the increased venous return.
31
Q

how big can a trained athletic person have a ventricular mass of compared to an untrained person

A
  • Trained athletes can have a left ventricular mass up to about 60% more than untrained people of the same height
32
Q

name an area that is sensitive to chronic hypertension

A

the eye

33
Q

what is damage to the eye and retinal vessels due to hypertension called

A
  • Damage to the eye and the retinal blood vessels is known as hypertensive retinopathy
34
Q

what does damage to the retinal vessels due to hypertension look like

A
  • Arteriolar narrowing and abnormalities at points where arterioles and venules cross. Manifestations of these changes include ‘Silver or Copper wire’ arterioles where the Centre of the (swollen) arteriole shines due to reflected light.
  • Chronic hypertension leads to hemorrhages from retinal capillaries. These show up in the ophthalmoscope as blot & flame haemorrhages, ’cotton wool spots’ and in severe cases swelling of the optic disc (papilledema, or optic disc edema)
35
Q

what can a combination of diabetes and hypertension lead to

A
  • A combination of diabetes and hypertension is particularly devastating for the retinal blood vessels and results in frequent haemorrhage and eventually severe sight loss unless treated.
36
Q

Name the 4 possible causes of hypertension

A
  1. Overactivity of the sympathetic nervous system
  2. Impaired production of nitric oxide
  3. Elevated renin release
  4. Reduced atrial natriuretic peptide release
37
Q

How can overactivity of the sympathetic nervous system cause hypertension

A
  • Since the sympathetic nervous system controls systemic vascular resistance (SVR), then overactivity will raise SVR. Blood pressure P = Cardiac output x SVR, so if cardiac output is constant and SVR increases, B.P. must rise
  • set point can rise in the medulla where the vasomotor control centre is found
  • Sclerosis or narrowing of arteries in the human brainstem could cause local hypoxia which could result in overstimulation of the sympathetic nervous system resulting in chronic hypertension
38
Q

how do you work out blood pressure

A

Blood pressure P = Cardiac output x SVR

39
Q

where is the set point for blood pressure found

A
  • set point is in the medulla where the vasomotor control centre is found
40
Q

how can impairment of production of nitric oxide cause hypertension

A
  • normal vascular endothelium is constantly generating NO
  • this diffuses into the smooth muscles and relaxes it
  • helps balance the vasoconstrictor effects of angiotensin and noradrenaline
  • injury to the endothelium by free radicals or pro-inflammatory cytokines can decrease NO production, leading to excess vasoconstriction and raised systemic vascular resistance
41
Q

name a protein that is strongly associated with hypertension

A

. Chronic inflammation as measured by C-reactive protein (CRP) is strongly associated with hypertension*

42
Q

how can elevated renin release cause hypertension

A
  • due to the angiotensin renin pathway

- Raised renin levels are found in the blood of some but not all patietns with hypertension

43
Q

how can reduced atrial natriuretic peptide release cause hypertension

A
  • Hypertension associated with raised plasma sodium may be due to a deficiency in atrial natriuretic peptide (ANP).
  • ANP is released from heart muscle cells in the atrial wall.
  • These cells contain volume receptors which respond to increased stretching of the atrial wall due to increased atrial blood volume.
  • ANP reduces the extracellular fluid (ECF) volume by increasing renal sodium excretion.
  • ANP acts on the kidney to dilate the glomerular afferent arterioles, constrict the efferent arterioles, and relaxes the mesangial cells that line the glomerulus.
  • This increases pressure in the glomerular capillaries, increasing the glomerular filtration rate (GFR), and increasing water excretion.
  • Loss of ANP can lead to salt and water retention and thus hypertension.
  • Stretching of the endothelium or smooth muscle of the atrial wall by hypertension could reduce the secretion of ANP; this will decrease GFR, and lead to excessive renin release, increasing the hypertension and starting a ‘vicious circle’
44
Q

reduced ANP may be why…

A

reduced ANP release may be why diuretics often work well in hypertension

45
Q

what is hyponatremia

A

Hyponatremia is a low sodium concentration in the blood.

causes the fluid to enter the cells and this can cause swelling

46
Q

what do salt reduction diets do for hypertension

A
  • Salt reduced diets in hypertensives have shown only small reductions in blood pressure and can have serious adverse effects
47
Q

is sodium good or bad for you

A
  • Lowering sodium intake may have adverse effects on vascular endothelium through stimulation of the renin-angiotensin system and on serum total and low density lipoprotein cholesterol concentrations.
  • In cohort studies, lower salt intake in people with hypertension has been associated with higher levels of cardiovascular disease and in general populations with greater all cause mortality (!)
  • However, among obese people lower salt intake is associated with a reduced risk of cardiovascular events.
48
Q

what is a serious side effect of hyponatremia

A

Hyponatremia is serious as it affects action potential production and can cause brain swelling!

49
Q

what are the symptoms of mild hyponatremia

A
  • Loss of energy and fatigue

- Confusion, Muscle weakness,

50
Q

what are the symptoms of severe hyponatremia

A

Nausea and vomiting, headache, Spasms

Restlessness and irritability, Seizures, Coma (all due to brain swelling)

51
Q

what is more important that the sodium level alone

A
  • the ratio between potassium and sodium
52
Q

what foods are high in potassium

A

most vegetables including beans (all types) potatoes, leafy greens, and most fruits especially bananas & avocados

53
Q

how many patients with type II diabetes have hypertension

A

• Hypertension is present in about 40% of patients with type II diabetes at age 45 rising to 60% at age 75.

54
Q

why do so many people with type II diabetes have hypertension

A

• The reason for this is not clear but it is suspected that the diabetes damages the endothelium and reduces NO production

55
Q

what causes the Link between obesity and primary hypertension

A

1)
- Obese individuals have high levels of leptin but often have a decreased sensitivity to leptin and thus their ‘ponderostat’ control is set too high.
- The high levels of leptin produce overstimulation of the sympathetic nervous system, especially the supply to the kidney.
- This may directly stimulate excess renin release.
2)
- Obesity is associated with hyperinsulinaemia and insulin resistance.
- hyperinsulinaemia can damaging endothelial walls and decrease nitric oxide production, thus increasing SVR and inducing hypertension

56
Q

What is leptin

A

Leptin is a hormone produced by fat cells, and in normal individuals it acts to limit long term food intake (increases sense of satiety) and thus maintain body weight at a set level

57
Q

what is hyperinsulinaeima

A

Hyperinsulinemia, is a condition in which there are excess levels of insulin circulating in the blood relative to the level of glucose

58
Q

According to NICE guidelines what is stage 1 hypertension

A

Stage 1 hypertension is where blood pressure is 140/90 mmHg or higher

59
Q

according to NICE guidelines what is stage 2 hypertension

A

Stage 2 hypertension is where blood pressure is 160/100 mmHg or higher

60
Q

in order to get drugs for stage 1 hypertension what else do you have to have

A
  • Target organ damage
  • Established CV disease
  • Renal disease
  • Diabetes
  • 10 year cardiovascular risk equivalent to 20% or greater
  • Get drugs
61
Q

what do people with stage 2 hypertension get straight away

A
  • Offer antihypertensive drug treatment to people of any age with stage 2 hypertension
62
Q

what lifestyle modifications can people make with hypertension

A
  • loose wiegt
  • exercise
  • diet rich in vegetables
  • low salt diet
63
Q

what is step 1 of NICE guidelines

A
  1. offer people under 55 years old ACE inhibitor or ARB
  2. offer CCB to people over the age of 55 years and to people of African or Caribbean family origin, if this is not tolerated then offer a diuretic
    3 if diuretic treatment is to be initiated offer a thiazide like diuretic such as chloratalidone or inadapamide
64
Q

what happens if you cannot tolerate an ACE

A

If an ACE inhibitor is prescribed and is not tolerated (for example, because of cough), offer a low-cost ARB. Do not combine an ACE inhibitor with an ARB to treat hypertension.

65
Q

why would you not give a CCB

A

If a CCB is not suitable, for example because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.

66
Q

why are beta blockers not a preferred initial therpay

A

Beta-blockers are NOT now a preferred initial therapy for hypertension due to a risk of developing diabetes

67
Q

what people are beta blockers considered in

A

Young people with…
• those with an intolerance or contraindication to ACE inhibitors and angiotensin II receptor antagonists or
• women of child-bearing potential
• people with evidence of increased sympathetic drive.

68
Q

what second drugs if needed should be added to a beta blocker

A

If therapy is initiated with a beta-blocker and a second drug is required, add a calcium-channel blocker rather than a thiazide-like diuretic to reduce the person’s risk of developing diabetes.

69
Q

what is NICE step 2

A

If blood pressure is not controlled by step 1 treatment, offer step 2 treatment with a CCB in combination with either an ACE inhibitor or an ARB.

  • if CCB not suitable then offer a thiazide like diuretic
  • for African or Caribbean family origin consider an ARB in preference to an ACE in combination with a CCB
70
Q

what is NICE step 3

A

If treatment with two drugs is not effective, the three-drug combination of ACE inhibitor or angiotensin II receptor blocker, calcium-channel blocker and thiazide-like diuretic should be used.

71
Q

what is NICE step 4

A

Blood pressure that remains higher than 140/90 mmHg after treatment with the optimal or best tolerated doses of an ACE inhibitor or an ARB plus a CCB plus a diuretic is classed as resistant hypertension; consider adding a fourth antihypertensive drug and/or seeking expert advice.

Cardiorespiratory 2 (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions