Blood Pressure Flashcards
How would you explain HTN to a pt?
Means high blood pressure which means the pressure of your blood going around your body is a bit high
Renal causes of secondary HTN (5)
Renal artery stenosis Chronic glomerulonephritis Chronic pyelonephritis PKD Chronic renal failure
Give a pregnancy cause of HTN
Pre-eclampsia
How is acute malignant HTN managed? (4)
- IV beta-blocker eg. esmolol
- Labetalol
- Hydralazine sodium nitroprusside
- Avoid rapid lowering of BP b/c it can cause cerebral infarction
When are ACEi or ARBs first line? (4)
<55 yrs
Diabetic
Heart failure
LV dysfunction
How is severe HTN managed?
Atenolol
Nifedipine
What are the lifestyle recommendations for lowering BP?
- Stop smoking
- <14 units/week or <1-2 units/day of alcohol
- Lose weight
- 30+ mins of moderate exercise 5+ days / week
Diet:
- Low caffeine
- Low salt: try avoid salty foods like crisps; try cook meals at home from scratch instead of having takeaway or processed foods; don’t add table salt; use herbs and spices to flavour food instead of salt; try have foods which say low salt on the packaging
- Avoid fatty or fried foods; use vegetable oil instead of animal fat
- 2-3 portions of oily fish a week; lean meat like chicken instead of ham/steak
- 5 a day
When may beta blockers be considered to treat HTN? (1)
Younger pts
Define Stage 1 HTN
SBP > 140 +/ DBP >90 on at least 2 separate occasions
AND
ABPM daytime average or HBPM average 138/85/+
When may alpha blockers be considered to treat HTN? (1)
Pts with prostate disease
What are the complications of HTN? (10)
CVS:
- Heart failure
- Coronary artery disease
- PVD
- Emboli
Neuro:
- Cerebrovascular accidents
- Hypertensive encephalopathy
- Posterior reversible encephalopathy syndrome (PRES)
Eyes:
- Hypertensive retinopathy
Renal:
- Renal failure
Malignant hypertension
Endo causes of HTN (8)
Diabetes mellitus Hyperthyroidism Cushing's syndrome Conn's syndrome Hyperparathyroidism Phaeochromocytoma Congenital adrenal hyperplasia Acromegaly
What is the target BP? (2)
- Non-Diabetic: < 140/90 mm Hg
- Diabetes without proteinuria: < 130/80 mm Hg
- Diabetes WITH proteinuria: < 125/75 mm Hg
Alpha blocker ending
-azocin
Define severe HTN
SBP 180/+
OR
DBP 110/+
Keith-Wagner Classification of HTN retinopathy
i. Silver wiring
ii. As above + arteriovenous nipping
iii. As above + flame haemorrhages + cotton wood exudates
iv. As above + papilloedema
CCB ending
-dipine
ARB ending
-sartan
Define malignant HTN
BP > 200/130
What to ask in a HTN history?
- What’s brought you in today? Any other presenting complaints?
- Every had BP done before? Anyone ever said you have high BP? Do you take medications to lower your BP?
- Do you take steroids or COCP?
- Smoked / caffeine / exercise within ~ the last 2 hours?
- Smoking history
- Alcohol history
- Diet history (breakfast, lunch, dinner, snacks and caffeine)
- Have you had / anyone in your family had: HTN, stroke, high cholesterol, IHD, diabetes (well controlled?)
When is medical Tx of HTN recommended?
SBP > 160 +/ DBP > 100
Or evidence of end-organ damage
What are the risks of using beta blockers to treat HTN? (2)
Combining with thiazide diuretic increases risk of developing diabetes
May increase risk of heart failure
Symptoms of accelerate or malignant HTN (6)
Scotomas (visual field loss) Blurred vision Headache Seizures Nausea and vomiting Acute heart failure
Drug causes of HTN (3)
Sympathomimetics
Corticosteroids
COCP
