49. Hypertension (50%) Flashcards
When to suspect secondary hypertension ? (3)
- young patients requiring multiple medications
- patients with an abdominal bruit
- patients with hypokalemia in the absence of diuretics
Describe : Hypertensive urgency
dBP≥130mmHg
Describe hypertensive emergency (5)
severe elevation of BP in the setting of any below
* Cerebrovascular
(1) Hypertensive encephalopathy
(2) Intracranial hemorrhage
- Cardiac
(1) Acute aortic dissection
(2) Acute LV failure
(3) Acute coronary syndrome - Renal : Acute kidney injury
- Pre-eclampsia/eclampsia
- Catecholamine-associated HTN
Describe diagnosis HTA during visit 1 (3)
- Require minimum of 3 readings during same visit (discard first reading) - gold standard is automated office blood pressure (AOBP)
- History and Physical (cardioresp, fundoscopy, bruits, peripheral pulse) +/- Labs
- If AOBP ≥ 135/85 or non-AOBP ≥ 140/90, out-of-office BP should be performed before Visit 2
Describe Out-of-office BP measurements (3)
can diagnose if any:
- Daytime ambulatory BP ≥ 135/85
- 24h ambulatory BP (ABPM) ≥ 130/80
- Daytime home BP (7d) ≥ 135/85
2 readings before breakfast, 2 readings 2h after dinner, eliminate day 1 readings and average other 6 days (total 24 readings)
Describe diagnosis HTA during visit 2,3,4,5
- Visit 2 : Mean OBPM (office BP measurement) ≥140/90 with macrovascular target organ damage, diabetes mellitus or CKD (eGFR<60)
- Visit 3 : Mean OBPM ≥160/100
- Visit 4-5 : Mean OBPM ≥140/90
Describe how to accurately measure BP (4)
- Cuff with appropriate bladder size (Bladder width 40% of arm circumference and length 80-100% of arm circumference)
- Nondominant arm, unless SBP difference >10mmHg (use higher value arm)
- Rest comfortably for 5 minutes in seated position, back support, arm supported at heart level
- No caffeine/tobacco 1h, no exercise 30mins preceding
Describe BP measurement in children (2)
- Consider BP measured annually in children and adolescents ≥3 y of age.
- Diagnosis of HTN if a child or adolescent if auscultatory-confirmed BP readings ≥95th percentile at 3 different visits. (c.f. Blood Pressure Table Pediatrics)
Name Target Organ Damage (5)
- Cerebrovascular
(1) Stroke
(2) Dementia (Vascular) - Hypertensive retinopathy
- Cardiac
(1) LV dysfunction
(2) LV hypertrophy
(3) Insuffisance cardiaque congestive
(4) Coronary artery disease (MI, angina, ACS) - Renal (CKD, albuminuria)
- Peripheral artery disease (claudication)
Name BP targets in HTA
- Diabetes <130/80
- All (including elderly and CKD) <140/90
- High risk consider ≤120
(1) SPRINT population ≥ 50yo
(2) CV disease
(3) IRC
(4) Framingham Risk Score (FRS) ≥15%
(5) Age ≥75yo
What to discuss during follow-ups ?
Assess global cardiovascular risk (site nice)
* Age ≥55yo
* Male
* Family Hx CAD (Age <55 in men, <65 in women)
* Sedentary lifestyle
* Poor dietary habits
* Abdominal obesity
* Dysglycemia
* Smoking
* Dyslipidemia
* Stress
* Nonadherence
Name routine labs HTA (5)
- FBG and/or HbA1C
- Lipid profile (serum total cholesterol, LDL, HDL, non-HDL, TG) fasting or non-fasting
- K, Na, Cr
- UA (r/o albuminuria which would guide treatment, eg ACEi/ARB)
- EKG
Name health behaviours to change (7)
- Exercise
- Weight loss (dietary education, physical activity, behaviour modification)
- Alcohol consumption (≤2 drinks per day (Men <14/week, women <9)
- Diet
- Stress management (cognitive behaviour interventions with relaxation techniques)
- Smoking cessation
- Re-assess habits (steroids, licorice), meds (NSAIDs, OCP), OTC meds
Describe exercise recommendaitons
30-60 mins of moderate-intensity dynamic exercise (walking, jogging, cycling, swimming)
** 4-7 days per week ** in addition to routine ADLs
What’s the weight loss goal ? (BMI, waist circumference)
- BMI 18.5-24.9
- waist circumference <102cm for men <88cm for women