[Cardio] Hypertension Flashcards
how is HTN diagnosed?
clinic BP >140/90mmHg → ABPM
clinic BP >180/120mmHg → same day assessment and rx
what do you do if ABPM is <135/85mmHg?
recheck 5 years
what do you do if ABPM is >135/85mmHg to <150/95 mmHg?
treat if:
- 10 year CVD risk >10%
- end organ damage
- DM / CVD / CKD
what do you do if ABPM is >150/95mmHg?
treat + assess for secondary causes if <40 years old
what are the sx of HTN?
- headache
- dizziness
- visual disturbance
- chest pain
when do you consider 2˚ HTN?
- <40 years without clear FHx or risk factors
- severe/resistant HTN
- malignant HTN with evidence of EOD
- HTN associated with electrolyte disorders
what are the causes of 2˚ HTN?
- renovascular (renal artery stenosis)
- primary kidney disease
- sleep apnoea syndrome
- endocrine: 1˚ hyperaldosteronism, Cushing’s syndrome, hypothyroidism, pheochromocytoma
how do you manage malignant HTN?
reduce BP slowly, aiming <160/120mmHg over hrs to days
what drugs can you use to reduce BP for malignant HTN?
- IV nitroglycerin (GTN)
- IV nitroprusside
- IV beta blocker e.g. Labetalol / Esmolol
- oral agents e.g. Amlodipine can be given if no EOD and pt asx
what is the 1st line mx for treating HTN and in whom do you give it?
A or C
A = ACEi or ARB; if <55 y.o. or DM at any age C = CCB; if Black African / African Caribbean or >55 y.o.
what is the 2nd line mx for HTN?
2 of A / C / D
D = thiazide diuretics
what is the 3rd line for mx of HTN?
A + C + D
how do you manage resistant HTN?
consider
- Spironolactone if K+ <4.5
- A-blocker / B-blocker if K+ >4.5
what is the HTN mx algorithm not used for?
- pregnant women
- CKD
what are the BP targets?
<140/90mmHg
<150/95mmHg if >80 y.o.
