Atherosclerosis & hypertension Flashcards
what is hypertension a major risk factor for
stroke and MI
who to treat for hypertension
all >160/100mmhg
types of hypertension
isolated systolic hypertension (ISH), malignant/accelerated phase hypertension, essential, secondary
what is the most common hypertension in UK
isolated systolic hypertension
what is isolated systolic hypertension
stiffening of large arteries (arteriosclerosis). not benign, x2 risk MI, x3 risk CVA.
what is malignant hypertension
rapid rise in BP- vascular damage- fibrinoid necrosis. severe hyper, bilat retinal hemorrhages and exudates, papilloedema. headaches, visual disturbance. can lead to renal, heart failure, encephalopathy.
what forms 95% cases of hypertension
essential (primary) cause unknown
what forms 5% cases of hypertension
secondary
causes of 2ary hypertension
renal (most common)- glomerulonephritis, PAN, polynephritis; endocrine- cushings, conns, acromegaly. others- coarctation, pregnany, steroids, the pill
hypertension tests
look for end organ damage- ECG (LVH, past MI), urine analysis, echo. special tests- renal ultrasound/ateriography, renin, aldosterone. 24h ambulatory BP monitoring (ABPM)
goals in hypertension treatment (+ in diabetes and elderly)
140/90. <130/80 in diabetics and 150/90 in elderly
monotherapy drugs hypertension for >55 and <55 patients
1st line- Ca channel blocker or thiazide if >55. if <55 ACEi. consider B blocker in younger patients
combination therapy hypertension
ACEi + Ca channel blocker or diuretic. if only on B blocker add Ca blocker over thiazide to reduce risk diabetes
malignant hypertension treatment
oral unless encephalopathy or CCF. avoid big drops in BP quickly due to poor cerebral autoregulation and so increase stroke risk.
what should you do if clinic BP is >140/90
offer ABPM
