3+ Essential Hypertension Flashcards
What is the definition of essential hypertension?
Blood pressure >140/90 mmol/mmHg with no secondary cause identified
What are the risk factors for essential HTN?
> 65
Alcohol use
Lack of exercise
Family Hx
Coronary Artery Disease
Obesity
Metabolic syndrome
Diabetes mellitus
Obstructive sleep apnoea
What is the pathophysiology of essential HTN?
BP is the product of cardiac output and peripheral vascular resistance
Affected by:
- Preload, contractility, vessel hypertrophy and peripheral constriction
- Most of these changes are associated with early + progressive small vessel atherosclerosis
What is the typical clinical presentation of essential HTN?
Mostly asymptomatic.
- Retinopathy
- Headache
- Dyspnoea (suggest HF or CAD)
- Chest pain (CAD)
- Anxiety
- Palpitations
- Nose bleeds
What bedside tests do you do for essential HTN?
ECG: may show LVH or old infarction
BSL
UA: increased albumin shows end-organ disease
What labs do you do for essential HTN?
- Lipid panel: high LDL, low HDL, high TGs
- FBC: check Hb (anaemia or polycythaemia suggest secondary cause)
- TFTs (secondary cause)
- Fasting metabolic panel: glucose, potassium, uric acid
- UECs: GFR shows renal insufficiency
- Plasma aldosterone
What other investigations do you do after bedside tests and labs for essential HTN?
Ambulatory blood pressure monitoring
Echocardiography: check for LVH and left ventricular function (rule out HF)
CT-angiography/renal artery duplex USS: see if stenosis, scarring
24hr pheochromocytoma screen
24hr urine free cortisol (cushing’s)
What is the DDx of essential HTN?
Drug induced
CKD
Renal artery stenosis (esp. younger patients)
Hyperaldosteronism
Hyperthyroidism
Cushing’s syndrome
Pheochromocytoma
What are the overall steps in management for essential HTN?
Lifestyle modification: physical activity, weight control, diet (minimise salt intake), smoking cessation, alcohol minimisation
Hypertensive drugs: ABCD
1. A = ACEI and ARBs
2. B= Beta-blockers
3. C = calcium channel blockers
4. D = thiazide diuretics
Do you use beta-blocks as a 1st line treatment in patients with uncomplicated HTN?
ETG says no. Use them in patients with HF-rEF or coronary heart disease
What is the difference between dihydropyridine and non-dihydropyridine calcium channel blockers?
Dihydropyridine: MORE vasodilation, LESS heart effect
Non-dihydropyridine: LESS vasodilation, MORE heart effect
What are some drug combinations recommended by ETG?
- Thiazide diuretic with an ACEI, ARB or B-Blocker
- ACEI or ARB with Calcium channel blocker
- B-Blocker with Calcium-channel blocker
- ACEI or ARB with calcium- channel blocker + thiazide diuretic
What are the common complications fo essential HTN?
Coronary artery disease
Cerebrovascular events
Left ventricular hypertrophy
Congestive Heart Failure
Retinopathy
Peripheral arterial disease
Chronic kidney disease
Aortic dissection
