Cardiovascular Disease - Hypertension Flashcards
What BP is classified as hypertension in clinic and at home/ambulatory readings?
Above 140/90 in a clinic or 135/85 with ambulatory or home readings
What percentage of hypertension are essential?
95%
What are possible secondary causes of hypertension? ROPE
R – Renal disease. This is the most common cause of secondary hypertension. If the blood pressure is very high or does not respond to treatment consider renal artery stenosis.
O – Obesity
P – Pregnancy induced
hypertension / pre-eclampsia
E – Endocrine. Most endocrine conditions can cause hypertension but primarily consider hyperaldosteronism(“Conns syndrome”) as this may represent 2.5% of new hypertension. A simple test for this is a renin:aldosterone ratio blood test.
Due to ‘white coat hypertension’ what is mainly used to diagnose hypertension?
This has led to the use of both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM)
What drugs may cause hypertension?
NSAIDs, Herbal remedies, oral contraceptive pill
What are hypertension risk factors as past medical history or family history ?
CVD, kidney disease, BP in pregnancy
Endocrine disease
What examination do you perform if you think someone has hypertension?
Pulse, rhythm, symmetry, radio-femoral delay, BP (both arms + standing), heart, chest, abdomen and fundoscopy
If BP is greater than 20mmHg in one arm compared to another, what do you do?
Repeated, if continued use higher value
Keep in mind other diseases which may cause this so listen to the heart
Do you take BP from both arms when diagnosing?
Yes
After you have taking a reading of both harms, do you take it again during consultation?
Yes, lower reading determines management if >140/90 mmHg
Then suggest ABPM or HBPM
If a person is going to take their BP at home what do you tell them?
Ideally in the morning or evening, twice daily you should take it when seating down 2 readings at leats a minute apart
Which BP readings do you use?
At least 4 to 7 days, discard day one and use the average of the other values
If an ABPM, what happens?
2 reading in waking hours, an average of at least 14
What is stage one hypertension in clinic vs home?
> 140 and >135 at home
What is a stage 2 hypertension?
> 160 or > or equal 150 at home
What is stage 3 hypertension?
> or equal 180
If a patient has 180/120 mmHg what do you do?
Admit speciality assessment if signs of accelerated hypertension or life threatening symptoms or pheochromocytoma
If no signs of an emergency, accelerated hypertension or pheochromocytoma, what do you do if your patient has BP of 180/120mmHg?
Check for organ damage if present give medication immediately without ABPM or HBPM if not then repeat BP within 7 days
How do you check of kidney damage?
Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess fo
What other tests can you do to check for organ damage?
Bloods for HbA1c, renal function and lipids
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities
What lifestyle advise should you give someone with hypertension?
reduce salt intake to <6g/day, ideally 3g/day
Reduce caffeine intake
stop smoking, drink less alcohol, eat a balanced diet rich in fruit and vegetables, exercise more, lose weight
When should medical management be offered for hypertension?
All patients with stage 2 hypertension
All patients under 80 years old with stage 1 hypertension that also have a Q-risk score of 10% or more, diabetes, renal disease, cardiovascular disease or end organ damage.
What is step 1 treatment for hypertension management for under 55 or T2DM?
ACE or ARB
What is step 1 treatment for hypertension management for >55 or black African?
CCB
If hypertension is not controlled in STEP 1 is not working?
Give CCB or thiazide if given ACE/ARB
If given CCB, then ARB over ACE or thiazide
What is STEP 3 treatment?
one of each
Either Ace/ARB
+
CCB
+
Thiazide
If none of medication work for hypertension, what is the 4th Step?
Seek specialist advice or 4th drug
Before checking with a specialist about persistent hypertension what should you do?
first, check for:
confirm elevated clinic BP with ABPM or HBPM
assess for postural hypotension.
discuss adherence
What is the 4th drug you would give a hypertensive patient if potassium is >4.5mmol/l?
Alpha or beta-blocker
If potassium is <4.5mm/l, what drug would you give to a resistant hypertensive patient?
Spironolactone
What is target BP for those <80 years old
140 or 135 at home
What is target BP for those >80?
150 or 145 at home
