lecture 10

Question 1

define hypertension

Answer 1

a condition where blood pressure is elevated to an extent where clincial benefit is obtained from blood pressure lowering

Question 2

what are tha main risk factors of uncontrolled bp

Answer 2

coronary heart disease
stroke
heart failure
renal failure
retinopathy

Question 3

outcomes of controlled blood pressure

Answer 3

reduced risk of heart attack by 20%, reduced stroke risk by 25%, reduce kidney disease by 25%, reduces overall mortality by 17% if normotensive level reached

Question 4

how does high bp lead to ischaemic heart disease or heart failure

Answer 4

high bp makes it harder for the heart to maintain cardiac output and oxygen demands, the heart then overworks => ischaemic heart disease/heart failure

Question 5

what factors make a pt have gigher risk of hypertension

Answer 5

existing CVD,elderly , diabeties, smoking, obesity, hyperlipidaemia, inactivity

Question 6

how is hypertension diagnosed

Answer 6

usually diagnosed through routine screening, as pt are mostly asymptomatic - the only symptom is really a headache ( some pt do get nosebleeds/blurred vision but rarely), bp should be meausred over repeat measurements across several weeks before diagnosis

Question 7

what clinical levels are consistent with diagnosis of hypertension

Answer 7

bp above 140/90

Question 8

what should target blood pressure be

Answer 8

mostly under 140/90, but if pt is diabetic or has existing CVD should aim for under 130/80

Question 9

Blood pressure classifications

Answer 9

normal is under 130/85 - 140/90
grade 1 is above 140/90
grade 2 is above 160/100
grade 3 is anything equal to or higher than 180/110

Question 10

what is isolated systolic hypertension

Answer 10

when the diastolic remains below 90 but the systolic is raised

Question 11

how to treat patients under 55 years old, who are NOT afro carribean who have hypertension

Answer 11

1st - Ace inhibitor or an ARB
2nd - combo of ACEi/ARB with Calcium channel blocker
3rd - Combo of A+ CCB+ thiazide/ thiazide - like diuretic
4th - add either alpha blocker, spironolactone, or a beta blocker

Question 12

why are beta blockers no longer first line in initial treatmenr

Answer 12

less effectibe in reducing cardiac events and linked to developmemt of diabeties when combined with a diuretic

Question 13

how to treat someone over 55 years old or anyone who is black/afro-carribean

Answer 13

1st calcium channel blocker
2nd Acei/arb + ccb
3rd ACEi/ARB+ CCB + thiazide/thiazide-like diuretic
4th A+C+D+ alpha blocker/beta blocker/spironolactone

Question 14

how do thiazides and potassium sparing work in a way where they can be used together

Answer 14

Bendroflumethiazide works higher up in the kidney to remove sodium (and potassium), while spironolactone works lower down, blocking aldosterone to retain potassium and reduce sodium reabsorption

Question 15

ACEi examples

Answer 15

ramapril, enalapril, lisinopril

Question 16

ARB examples

Answer 16

losartan, candesartan, irbesatan

Question 17

CCB examples

Answer 17

amlodipine, nifedipine

Question 18

side effect of ACEi

Answer 18

angiotensin 2 breaksdown bradykinin, since your reducing angiotensin 2 levels, bradykinin is accumulated. This can cause a chronic dry cough. switch these pts to an ARB

Question 19

what is the cause of hypertension in white people under 55

Answer 19

malfunction in the RAAS system - too much ag2 and aldosterone produced

Question 20

what is the cause of hypertension in black people or white people over 55

Answer 20

overstimulation of the sympathetic nervous system via baroreceptor overstimulation.

Question 21

what is a cause of hypertension which cant be treated

Answer 21

inflammation in arteriole system which reduces the lumen site

Question 22

when should use of an ACEi or ARB be avoided

Answer 22

young females of child baring age - these drugs are contraindicated in pregnancy

Question 23

when to avoid use of a beta blocker

Answer 23

patients with asthma -theyre not specific so if you blocl beta 2 in the lungs then itll case broncoconstriction

Question 24

when to avoid use of non-dihydropyridines

Answer 24

if pt is already on another rate limiting drug like a beta blocker ( heart rate will be reduced too much)

Question 25

what do beta blockers not protect against

Answer 25

stroke

Question 26

where are beta blockers used most often , meaning these conditions alongside hypertension would be when bb could be used first line

Answer 26

angina/ ischemic heart disease

Question 27

who should not recieve a diuretic

Answer 27

someone with bladder or prostate problems

Question 28

alpha blocker examples

Answer 28

doxasozin, prazosin, tamsulosin

Question 29

side effects of beta blockers

Answer 29

fatigue/cold extremities

Question 30

calcium channel blocker side effects

Answer 30

constipation, peripheral oedema

Question 31

diuretic side effects

Answer 31

make you pee more

Question 32

when is aspirin used

Answer 32

secondary prevention or primary prevention if pt is at very high risk ( usually only used in old people with high risk factors of a cardiovascular event occurring) dont start unless normotensive

Question 33

secondary prevention atorvastatin dose

Answer 33

40-80mg

Question 34

aims in secondary prevention statin

Answer 34

LDL <2 or total <4 (mmol/L)

Question 35

primary atorvastatin dose

Answer 35

20mg

Question 36

when to start primary statin

Answer 36

if Q risk is 10%+ , and also considered in t1dm if had it for a long time

Question 37

target for primary statin

Answer 37

no cholesterol target , will also have necessary pleotropic effects

Question 38

what drugs exacerbate hypertension and how

Answer 38

NSAIDS - increase fluid build up due to build up of sodium Oestrogens - cause fluid retention sympathomimetics ( xylometazoline ) - weak versions of adrenaline so cause vasoconstriction corticosteroids - fluid retention via aldosterone medicines with high sodium eg antacids, effervecents etc