Pathology > Hypertension > Flashcards

Hypertension Flashcards

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1
Q

How many are worldwide hypertensive?

A

1/4 of the worlds population

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2
Q

Are more females or males over 20 years affected?

A

More females

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3
Q

How many do not know that they are hypertensive?

A

1 in 3 aduls

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4
Q

How how many cannot t keep it under 140/90?

A

1 in 3 adults

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5
Q

How do we measure blood pressure?

A

With a spygomanometer

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6
Q

What do we have to do before administration local anaesthesia?

A

Obtaining blood pressure

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7
Q

Why do we have to do it?

A

1- to treat patients in a safer environment

  1. to imporive Overall outcomes for patients
  2. to refer patients early for hypertension management
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8
Q

What are cardiovascular damage risk factors?

A
  1. Age
  2. HBP
  3. Diabetis
  4. Genetics
  5. Obesity
  6. Sedentarism
    7- Tobacco
  7. Lipids
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9
Q

Regarding the framingham Study, what are risk factors?

A
  1. Age
  2. Total cholesterol
  3. Tobacco
  4. HDL
  5. BP
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10
Q

When do we consider regarding the Framingham study blood pressure as high?

A

high > 20% or `2ß%

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11
Q

When do we consider it as intermediate?

A

7,5-19.9%

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12
Q

What are non modifiable risk factors?

A
  1. Agen and sex

2. Family history, genetics

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13
Q

What are modifiable and/ or treatable risk factors?

A
  1. Tobacco
  2. Arterial Hypertension
  3. Diabetes
  4. Obesity. Sedentarism
  5. Hypercholesterolemia (LDL)
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14
Q

Whats the metabolic syndrome?

A

A combination of medical disorders that, when occurring together, increase the risk of developing CARDIOVASCULAR DISEASE and DIABETES

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15
Q

What includes the metabolic syndrome?

A 
Hypertension >130/85 mmHg
• Hyperglycemia >100 mg/dl fasting
• Low HDL-cholesterol <40mg/dl ♂ <50 ♀
• Hypertriglyceridemia >150 mg/dl
• Waist circumference >102 cm ♂ >89 cm ♀
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16
Q

On what is the metabolic syndrome focused?

A

Concept of metabolic syndrome focused on dysregulation of

adipocytokines induced by visceral fat accumulation

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17
Q

Metabolic syndrome starts with visceral fat accumulation:

A

Then goes to Hyperlipidemia, Hypertension, Diabetes mellitus and ends in Artherosclerosis

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18
Q

What are risk factors for developing Atherosclerosis?

A

Cardiovascular risk factors

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19
Q

What are cardiovascular disease?

A
  1. Heart (Heart failure etc.)
  2. Brain vessels
  3. Peripheral artery disease
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20
Q

What is a peripheral artery disease?

A

Intermittent claudification

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21
Q

Due to the regulation of blood pressure: what’s a quick response?

A

Autonomic nervous system

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22
Q

Due to the regulation of blood pressure: what’s a slow response?

A

Renin- angiotensin aldosterone system

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23
Q

How many are affected by primary or essential HBP?

A

95%

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24
Q

How many are affected by secondary HBP?

A

5% due to an underlying disease

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25
What are essential or primary HBP?
Primary hypertension or idiopathic hypertension
26
Whats pathogenicity?
No identifiable cause
27
What are risk factors of HBP?
- racial and genetic - sodium intake - alcohol consumption- - obesity - lipids
28
What should be respect in the office?
``` Two readings 5 mins apart sitting in chair confirm elevated reading in contralateral arm White coat hypertension ```
29
When do we suffer a hypertensive crisis?
Grade 3 Hypertension more than 180 and 110
30
When do we treat Hypertensive patients?
Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease
31
What is the first thing we treat?
Lifestyle
32
Initial drug choice:
- without compelling indications | - with compelling indications
33
Without compelling indications:
Stage 1 | Stage 2
34
With compelling indciations
Drugs for the compelling indication
35
Treating hypertension:
1. Reduce/ optimize control of other cardiovascular risk factors 2. anti hypertensive drugs
36
Anti Hypertensive drugs:
1. Diuretics 2. ACE inhibitors/ ARCs/ Renin inhibitors 3. ß blockers/ alpha blockers 4. Calcium channel blockers
37
What is mostly the first choice if diet and exercise aren't enough?
Diuretics
38
What do diuretics do?
They help the body shed excess sodium and water to lower blood pressure
39
What do ACE inhibitor do?
reduce bodys supply of angiotensin II a substance that makes blood vessels contract and narrow
40
What do ARBs do?
They block receptors for angiotensin
41
What do ß blockers do?
They slow the heart rate which means that the work doesnt have to work that hard on ß recesptors
42
What do calcium channel blockers do?
Slow the movement of calcium into the cells of the heart and blood vessel
43
What does the initial therapy include?
ACEIs or ARB plus CCB or diuretics
44
What does the step 2 trickle combination include?
ACEis or ARB plus CCB plus diuretics
45
What does the step 3 triple combination include?
Resistant hypertension, add spironolactone or other diuretic, alpha blockers or beta blockers
46
When should be consider beta blockers?
Whenever there is a specific indication for their use e.g heart failure, angina, atrial fibrillations etc.
47
When do you reach the Hypertension danger zone?
high blood pressure if reading average 140/ 90 or higher, even if you dont have symptoms
48
When can you have a hypertensive crisis?
at 180/110 and higher
49
Whats if patient has 180-209/ 110-119 can we treat?
No dental treatment without medical consult, refer for prompt medical consult
50
What if we have a patients with 180-209 and 110-119, can we teat?
No dental treatment, refer for emergency medical treatment
51
What if we have a patient with 210 or more and 120 or more, can we treat?
no dental treatment, refer for emergency medical treatment
52
Whats with patients with BP less than 180/110?
For patients with this pressure, and no evidence of target organ involvement Andy dental treatment may be provided
53
Whats during the treatment?
- local anesthesia excellent quality - avoid epinephrine containing gingival retraction cord - patients upper level of stage 2, consider intraoperative monitoring of BP and terminate appointment if BP reaches 180/ 110
54
Whats after the treatment?
- slow chase position - record pre and post operative vitals in axiom . caution by prescribing post operative antibiotics as some can act with antihypertensive mediations and enhance hypotension
55
What can we get by treating hypertension?
oral manifestations
56
What can give calcium channel blockers?
Gingival owergrowth/ hypertrophy
57
What can give AcEIS?
Neutropenia, delayed health, gingival bleeding etc
58
What can give diuretics?
dry mouth
59
When might we get lichenoid reactions?
Thiazides, methydopa, labetalol
60
What are common side effects of anti hypertensive drugs? | wichtig
- gingival hypertrophy - Xersotomia and its consequences - lichenoid reactions . Orthostatic hypotension
61
What can reduce the efficacy of HPB and increase cardiovascular risk?
long term NSADIS
62
Whats a Hypertensive crisis? | wichtig
Several elevated BP that puts the cardiovascular system integrity at risk
63
When do we mostly get a hypertensive crisis? | wichzig
BP more than 180 or more than 110 180/110
64
When do we have a hypertensive danger zone`
high blood pressure 140/90 or higher
65
When may we get a hypertensive crisis?
at 180/ 110 and higher, rest for a few minutes and take blood pressure again, if still high, emergency
66
What might be a consequence of a hypertensive crisis?
Can lead to stroke, heart attack, kidney damage or loss of conciousness
67
What might be symptoms of a hypertensive crisis?
severe headache, anxiety, nosebleed, feeling short of breath
68
When do we have a Hypertensive URGENCY?
Asymptomatic= no symptoms relative rapid but progressive during hours/ days (<160/100) stabilize in 24-48h NO SUBLINGUAL DRUGS such nifedipine
69
When do we have a Hypertensive Emergency?
>180/110 plus symptoms Serious tissue damage treating life ``` Immediate transfer to a hospital ICU admission: - expect care - monitoring - immediate progressive BP lowering =PARENTERAL THERAPY ```
70
What are considered Hypertensive emergencies?
- cerebrovascular diseases- stroke - cardiac (dissection, left ventricular failure) - Renal - excessive circulating catecholamines - Eclampsia - Surgical
71
What to do by an Hypertensive Emergency?
1. call EMS | 2. lower BP immediately in ICU
72
What to do by Hyptertensice Urgency?
lower BP slowly and progressively
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