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MBBS VI - SpC - Family Medicine > Chronic diseases: Hypertension > Flashcards

Chronic diseases: Hypertension Flashcards

1
Q

Hypertension

Definition
Primary and secondary causes

A
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2
Q

Hypertension

Clinical presentation
Complications

A
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3
Q

Hypertension

NICE management algorithm

A
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4
Q

Types of BP measurement

Function of ABPM

A
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5
Q

Cut-offs in different types of BP measurement

A
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6
Q

Iatrogenic errors in BP measurement

A
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7
Q

Hypertension

Clinical variants and stages

A
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8
Q

Hypertension

Risk factors for poor prognosis

A
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9
Q

Hypertension

Management goals and targets

A

Goals of Treatment
- Maximal reduction in total risk of CVD (require both treatment of other risk factor + BP control)
- Achieve optimal/ normal/ high normal OBP(different range in different age
- Good communication for lifelong successful management

Standard OBP Targets
- General: <140/90 mmHg - ↓ risk of CHF by 50%, Stroke by 35-40%, AMI by 20-25%
- Diabetic: <130/80 mmHg
- CKD: <130/80 mmHg
- Depends on baseline BP and no. of risk factors e.g. DM, CKD, Hx of MI, Stroke, Advanced age

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10
Q

Hypertension

Pharmacological treatment options

A

Consider to start drug treatment in patients with sustained systolic blood pressures ≥ 140mmHg or diastolic blood pressures ≥ 90mmHg despite lifestyle modification for 6 months or if target organ damage is present.

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11
Q

Hypertension

ACEi/ ARB indications and contraindications

A
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12
Q

Hypertension

B-blockers, CCB indications and contraindications

A
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13
Q

Hypertension

Thiazide and K-sparing diuretics indications and contraindications

A
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14
Q

Hypertension

Management of refractory HTN

A
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15
Q

Hypertension

HBPM advice

A
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16
Q

ABPM

Abnormal BP cut-offs

A
17
Q

Hypertension

Review period and management for range of BP

A
18
Q

Hypertension

Cardiovascular risk factors

A
19
Q

Hypertension

Non-pharmacological advice

A

Lifestyle modification:
- Dietary Approaches to Stop Hypertension (DASH) eating plan: rich in fruits, vegetables, and low in fat dairy products with a reduced content of dietary cholesterol as well as saturated and total fat
- Dietary sodium restriction: reduce salt intake to less than five grams (around one teaspoon of table salt) per day and not to use added salt.
- regular physical activity
- stress management
- Smoking cessation
- Alcohol cessation: Reduce alcohol intake in hypertensive patients to no more than two standard drinks per dayb for men and one standard drink per day for women
- Weight loss and maintenance

20
Q

Hypertension

Follow-up plan

A

After initiating antihypertensive drug treatment, most patients should be followed up within 2 weeks until the blood pressure goal is achieved.

More frequent visits may be indicated for patients with systolic blood pressure ≥ 160mmHg or diastolic blood pressure ≥ 100mmHg or with complications.

Once the blood pressure goal is achieved, the follow-up interval may be extended to 6-12 weeks depending on the patient’s condition and the doctor’s assessment.

21
Q

Hypertension

Immediate referral signs

A
22
Q

Hypertension

Specialist referral signs

A
23
Q

Hypertension

Patient’s Knowledge, Skill and Behaviour Checklist

A
24
Q

Features of secondary hypertension

  • OSA, Renal disease, Aorta disease, Hyperaldosteronism, Excess catecholamines
A
25
Q

Features of secondary hypertension
- Cushing’s, Drug-indiced, diet, EPO-induced, Thyroid disorders

A
26
Q

Hypertension

Evaluation for new hypertension

A

Physical examination
* Body weight, height, Body Mass Index
* Features of Cushing’s syndrome / Acromegaly (endocrine case of HT)
* Skin stigmata of neurofibromatosis (phaeochromocytoma)
* Radial/brachial femoral delay, precordial or chest murmurs (aortic coarctation or aortic disease)
* Abdominal examination: enlarged kidney, abdominal bruit
* Signs of organ damage: peripheral arterial disease, fundi abnormalities, carotid bruit, neurological defects, CVS examination

27
Q

Hypertension

History taking quesitons

A
28
Q

Hypertension

Investigations

A
29
Q

DASH diet plan

A

The DASH eating plan has the following characteristics:
* Rich in fruits, vegetables
* Rich in potassium, magnesium and calcium
* Low in cholesterol, saturated and total fat
* Low in sodium
* Low in sweets and added sugars

Key points:
- Sodium: <5g per day
- Potassium rich food from fruit and vegetables (unless CKD or K+ diuretics)
- Complex carbohydrate with high fiber foods for 50% energy intake
- 4-5 servings of fruit and vegetables per day
- Lean protein for 20% total energy intake
- Fat for <30% energy intake with low saturated fat and low cholesterol, trans fat
- Alcohol consumption: <2 unit/ day for man, <1 unit per day for woman

30
Q

Exercise prescription for hypertension

Key points for advice

A

Frequency: Aerobic on all days, resistance 2-3x per week
Intensity: Aerobic at moderate intensity (40-60% VO2 max or 50-70% max heart rate)
Time: 30-60 mins aerobic per day, 8-10 types of resistance exercise with 1 set minimum each
Type: Aerobic i.e. walking, jogging, cycling and swimming, rope skipping
Resistance: Machine or free weight

Risks and precaution:
- Intensive isometric exercise such as heavy weight lifting can have a marked pressor effect and should be avoided
- If hypertension is poorly controlled, heavy physical exercise as well as maximal exercise testing should be discouraged or postponed until appropriate drug treatment has been instituted and blood pressure lowered
- Keep BP <220/105 during exercise
- B-blocker and diuretic users: risk of hypoglycaemia and hyperthermia
- CCB, a-blockers and vasodilator users: sudden post-exercise hypotension
- Monitor for cardiac prodromal symptoms

31
Q

Cardiovascular risk assessment tools

A
32
Q

Hypertension

Lipid profile targets

A
33
Q

Hypertension

Management of concomitant lipid disorder

A

Lifestyle modification
- Reduction of dietary fat intake
- Total fat <30% of total calorie/day
- Saturated fat <7%, cholesterol <200 mg, trans fat <1% of total calorie intake/day

Drug treatment:
- Statin
- Fibrate (no strong evidence for using fibrate therapy in primary prevention of cardiovascular disease. The use of fibrates in these patients should only be considered when statins are contraindicated)
- Ezetimibe ( add-on drug in association with statins when the therapeutic target is not achieved at the maximum tolerated statin dose, or as an alternative to statins in patients who are intolerant of statins or with contraindications to statins)

34
Q

Hypertension

Algorithm for statin useage

A
35
Q

Statin use monitoring

A
36
Q

Statin

D/D interactions

A

MBBS VI - SpC - Family Medicine (42 decks)

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