0805 - hypertension - AHF Flashcards
How many Australians are diagnosed with hypertension?
1 in 3; it is the most frequently managed chronic problem in general practice; it is predominantly asymptomatic.
Outline some valuable resources for cardiology.
- www.heartfoundation.org.au - cardiac society of Australia and New Zealand (www.csanz.org.au) - FASEB journal (Federation of American society for experimental biology)
Define white-coat hypertension.
Px exhibits elevated blood pressure in clinical setting.
Define masked hypertension.
Px exhibits elevated blood pressure in daily living, but reduced BP in clinical setting.
Sub-optimal BP (systolic > 115 mmHg) accounts for what percentage of the global burden of disease?
4.4%
Explain the link between hypertension and the progression of CVD.
What is the device used to measure BP?
Sphygmomanometer.
Define blood pressure.
Pressure exerted by circulating blood upon the walls of blood vessels; refers to systemic circulation (usually the arteries) unless otherwise specified; aka MAP.
What determines BP (MAP)?
MAP = CO * TPR MAP = HR * SV * TPR (CO around 5 L/min at rest)
Define vascular resistance.
The resistance to flow that must be overcome to push flood through the circulatory system.
What is important in the diagnosis of hypertension?
The diagnosis must be based upon multiple readings.
Outline the diagnostic categories of blood pressure in adults.
What is the most common cause of hypertension.
Idiopathic (lifestyle, genetic).
Why should we assess all patients with hypertension?
- to identify all CVD risk factors - to calculate absolute risk - to detect end-organ damage (e.g. heart, kidneys) - to detect co-morbid conditions - to identify causes of secondary hypertension
Define absolute risk.
The numerical probability of a cardiovascular event occurring within a five-year period. It reflects a person’s overall risk of developing CVD replacing the traditional method that considers various risk factors, such as high cholesterol or high blood pressure, in isolation.
How does absolute risk affect the treatment of hypertension?
“Not just looking at the BP number, but the company it keeps.” Px with: - high absolute risk: treat as CHD equivalent; do not wait for the disease to develop - intermediate absolute risk: may require intensive treatment; more information required - low absolute risk: intensive treatment not required
Outline the groups at high absolute cardiovascular risk
Group A: patients aged 75 years and old Group B: patients with existing CVD Group C: patients with associated clinical conditions and/or end-organ disease
Why should we intervene for a Px with hypertension?
- reduce BP - reduce absolute cardiovascular risk - minimise end-organ damage
When should we initiate drug treatment for a Px with hypertension?
- grade 3 hypertension - isolated systolic hypertension with widened pulse pressure - systolic ≥ 160 mmHg and diastolic ≤ 70 mmHg - associated conditions or target-organ damage
What are the two avenues of hypertension management?
- lifestyle modification - pharmacologic therapy o low does thiazide diuretic o beta-blocker o ACE inhibitor o calcium channel blocker
What are the BP targets for: a. adults ≥ 65 years old (unless diabetes and/or renal insufficiency and/or proteinuria ≥ 0.25 g/day) b. adults 1 g/day (with or without diabetes
a.
Why may BP be resistant to treatment?
- non-compliance - undiagnosed secondary hypertension - hypertensive effects of other drugs - treatment resistance due to sleep apnoea - undisclosed use of alcohol or recreational drugs - unrecognised high salt intake - volume overload, especially with chronic kidney disease - technical factors affecting measurement - white-coat hypertension
