4/5) primary hypertension - classification , stages and degrees and therapy Flashcards
what is hypertension ?
persistent blood pressure of 140/90 mmhg
what is the aetiology of primary hypertension ?
non specific lifestyle changes and genetic factors it is multifactorial
clinical signs and symptoms for hypertension ?
usually asymptomatic
retinopathy left ventricular hypertrophy proteiurea renal angiopathy - affecting afferent arterioles - hyalinisation fibrinoid necoris myocardial infraction stroke
what is the diagnosis of hypertension and classification according to diagnosis
Hypertension is diagnosed if blood pressure is persistently elevated on two or more separate measurements
prehypertensive 130-139 /85-89
grade 1 140-159/90-99
grade 2 - more than 160-179 / 100-109
grade 3 (hypertensive crisis ) 180/ 110
fasting blood glucose
evaluation of end organ damage - complete blood count , kidney function test , ECG
in diabteic patients what do we aim the blood pressure to be ?
130/80
what is the the treatment to hypertension ?
life style changes - salt consumption excercise
reduce alcohol
long term treatemnt
--------------------------- diuretics - hypokalaemia increase uric acid = bad for gout ototoxicity - loop increase insulin resistance = bad for diabetes !!!
ACEI dry cough hyperkalemia contra - bilateral renal artery stenosis angioneurmtic edema
ARB
hyperkalemia
—————————–
Beta blockers
bronchoconstriction , bradycardia ,
av block
increase insulin resistance
aldosterone anatagonist - spironolactone , eplerenone
alpha adrenergic blockers
------------- renin inhibitor - aliskiren hyperkalemia diarrhea ----------------------- calcium channel antagonist - nifedipine gingival hyperplasia ankle edema bradycardia , conduction (non DHP
dhp contra - tachyarythmia
NON DHP contra -av block
who is diuretics suited for ?
initial treatment for elderly
isolated systolic hypertension
CHF with edema
acute HF - loop
who is ACEI suitable for ?
diabetes mellitus
chf
nephropathy / microalbuinurea
who is ARB suitable for ?
MAU
Diabetic nephropathy - metabolically inert
who is beta blockers suited for ?
initial therapy for the young CHD post MI tachyarrythmia labetelol pregnancy
calcium channel blocker suitable for ?
COPD / asthma metabolic syndrome and diabetes isolated systolic hypertension - DHP pregnancy - nifedipine PERIPHERAL VASCULAR DISEASE - SPASMA supra ventricular tachycardia - non DHP
who is alpha adrenergic blockers suitable for ?
diabetes - good metabolically
prostate hypertrophy
lipid disorder
what are the drug to drug interactions that should be avoided
ACEI WITH ARB/ or aldosterone antagonist / RAAS system drugs in combo bad = hyperkalemia
hypertension leads to increase risk of what diseases ?
cardiovascular
congestive heart failure - hypertrophic cardiomyopathy
coronary artery disease - arthersclerosis
aortic aneurysm
aortic dissection!!
brain - stroke
haemorrhage
memory loss
kidney
hypertensive nephrosclerosis - focal segmental glomerulosclerosis
= microalbuminurea
microhematurea
biopsy - sclerosis on capillary tufts and arterial hyalinosis
retinopathy
fundoycopic examination - retinal haemorrhages
cotton wool spots
macular star
who is isolated systolic hypertension common in?
in elderly - decreased arterial elasticity
