C23. Hypertension Flashcards
what is hypertension
high blood pressure. Medical condition characterized by persistently elevated pressure within large arteries
what is BP measured in
mm of mercury
how do you write BP
systolic over diastolic mm of mercury
what is systolic pressure
maximum pressure within large arteries when the heart muscle contracts to propel blood through the body
what is diastolic blood pressure
the lowest pressure within the large arteries during heart muscle relaxation between beating
what are the determinants of blood pressure
Cardiac output
peripheral vascular resistance
Blood volume
what is cardiac output
volume of blood pumped by the heart per minute
what is peripheral vascular resistance
the resistance to blood flow in the peripheral blood vessels
what are the determinants of hypertension
altered BP regulation
Genes
lifestyle
environment
what numbers define hypertension
sustained SBP >140
sustained DBP >90
what are the two types of hypertension
essential and secondary
what is essential/primary hypertension
no clear single causes
complex genetic background and environmental factors
most common form of hypertension in adults
what is secondary hypertension
specific underlying cause
5-10% of cases of adults
70-85% cases in children
so the definition of essential Hypertension is…
“Essential Hypertension” is a persistently elevated blood pressure without an identifiable secondary cause
what are some manual auscultatory devices used in practice
BP cuff, stethoscope
what are some automated electronic devices used in practice
digital/electronic bp monitor
in what environment would you measure BP and how would you have your patient
use a relaxed setting with a person quiet and seated
what should you do before taking a BP reading
check the pulse if its irregular take the BP manually and ensure the device is validated and you are using the right sized cuff
what is a ABPM
ambulatory Blood pressure monitor
which method of taking blood pressure is the most accurate and useful and why
ABPM because it provides multiple readings in conditions that reflect the usual environment like daily activities and sleep
so hypertension must be diagnosed with ABPM or……….
Home BP
how many readings do you need an hour if you are using ABPM
at least two measurements per hour during the person’s usual waking hours (usually 14/day).
how many measurements do you need if you are using a HBPM
two consecutive seated measurements 1 minute apart
BP is recorded x2 a day for min of 4 days and preferably a week
when using HBPM which measurements are discarded
the first days measurements and then an average is used for the rest
what is it called when BP goes up because it is being measured at the GP
white coat effect
what is masked hypertension
having normal BP in clinic but elevated BP at home
what could eb possible reasons for masked hypertension
young age, male, stress (ie in calm moments there bp could be almost normal )
what are the stages of hypertension
1, 2 and severe
what is stage one hypertension
office BP is 140/90 or higher
ABPM/HBPM daytime average is 135/85 or higher
what is stage 2 hypertension
office BP is 160/100 or higher
ABPM/HBPM daytime average is 150/95 or higher
what is severe hypertension
office SBP is 180/90 or higher
office DBP is 110 or higher
what tests should you do for hypertensive people to assess their organ damage
test urine for presence of proteins
blood to measure glucose, cholesterol, electrolytes, creatinine
arrange an ECG - (LVH?)
examine fundi for hypertensive retinopathy
what conditions can be developed due to prolonged HBP
Left Ventricular Hypertrophy - can lead to heart failure
raised creatinine levels - kidney damage
albumin present in urine - kidney damage
retinopathy
what are established vascular diseases linked to HPB
Ischaemic Heart Disease
Cerebrovascular Disease
PVD
diabetes
how do you asses someone for Hypertension
Medical history
Family History
Smoking
Alcohol
Sleep history
CV examinations (pulses, bruits)
ABPM ? HBPM
examine Fundi
what are the classes of retinopathy
Grade I, II, III, IV
why do we check the fundi in hypertensive patients
Examining the fundi is crucial for detecting hypertensive retinopathy, which can indicate the severity and duration of hypertension. It helps in early detection, assessing the overall cardiovascular risk, monitoring progression, and preventing vision loss.
what is secondary hypertension
Secondary hypertension is high blood pressure caused by another medical condition.
what are some common causes of secondary hypertension
Obstructive sleep apnoea
renal disease
aldosteronism
renovascular disease
what are the more uncommon causes of secondary hypertension
Cushing’s
Hyperparathyroidism
aortic coarctation
