Hypertension Flashcards
(25 cards)
What is stage 1 hypertension?
More than or equal to 140/90mmHg clinic BP
What is stage 2 hypertension?
More than or equal to 160/100mmHg clinic BP
What is stage 3 hypertension?
Clinic systolic BP greater than or equal to 180mmHg and/or diastolic BP greater than or equal to 110mmHg
What can hypertension be divided into?
Primary (Essential) or secondary
What factors can be involved in causing primary hypertension?
- Genetic susceptibility
- Excessive sympathetic nervous system activity
- Abnormalities of Na+/K+ membrane transport
- High salt intake
- Abnormalities in renin-angiotensin-aldosterone system
What is secondary hypertension most commonly caused by?
Renal disease or pregnancy
What is the most common cause of secondary hypertension?
Chronic Kidney Disease
What is the most common cause of CKD?
Diabetes
What endocrine diseases can cause secondary hypertension?
- Cushings syndrome (hypersecretion of corticosteroids results in hypertension)
- Conns disease (increase aldosterone secretion)
- Pheochromocytoma (secretes catecholamines which can cause hypersion)
What drugs are associated with causing hypertension?
Prescription
- Corticosteroids e.g. Prednisolone
- Cyclosporin
- Erythropoietin
- Some types of the contraceptive pill
Non-prescription
- Alcohol
- Amphetamines
- Ecstasy and cocaine
With hypertension what effects are there on the vessel?
- Accelerates atherosclerosis
- Causes the thickening of the media of muscular arteries
- Smaller arteries and arterioles especially affected
What effect can hypertension have on the heart?
Major risk factor for IHD
What effect can hypertension have on the nervous system?
Intracerebral haemorrhage which is a frequent cause of death
What effect can hypertension have on the kidneys?
- Can be the cause or result of renal disease
- Kidney size is often reduced and small vessels show intimal thickening and medial hypertrophy and the numbers of sclerotic glomeruli are increased
How does malignant hypertension present?
- Markedly raised diastolic BP and progressive renal disease.
- Renal vascular changes are prominent and there is usually evidence of acute haemorrhage and papilloedema
What is papilloedema?
Optic disc swelling caused by increase intracranial pressure
What are the consequences of malignant hypertension?
- 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
What are the risk factors for hypertension?
- 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
- Other medicines - oral contraceptive, SNRI antidepressants
What investigations would you do in hypertension and why?
Looking for end organ damage and patients with secondary causes of hypertension.
- ECG
- Urinalysis
- Blood tests
- Echocardiogram
What is the non-pharmacological treatment for hypertension?
- 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
(Lose 1kg in weight = can reduce 1 tablet)
What is the pharmacological treatment pathway for hypertension?
ACD pathway
A - ACE inhibitor
C - Calcium channel blocker
D - diuretic
What is the first line treatment for someone with hypertension under the age of 55 as apposed to over the age of 55?
- Under 55 = ACE inhibitor
- Over 55 = Calcium channel blocker
Give an example of an ACE inhibitor?
Ramipril
Give an example of a calcium channel blocker?
Amlodipine
