Clinical Hypertension Flashcards
CVD/risk is environmental more then genetic!
Seen within different countries
Why is 140/90 not true as ‘normal”
So variable!
Why is there such an issue in BP
- Causes cerebrovascular accident (stroke) : ischemic stroke(clot), haemorrhagic stroke(burst)
- Transient ischemic attack (TIA): a reversible stroke
- CVD, MI, angina
- kidney damage
- peripheral vascular disease
- aortic aneurysm
Synergy of risk factors
Smoking (worst), blood cholesterol, gender, age, diabetes all synergise to increase the risk
CVD explain
BP ~ 18% risk increase
How do we know all this info about BP
From cohort studies (british doctors studies)
RCT: show us treatment effect
Age is worse then High BP
if you look at mortality rates
Differing B at times of the day/year
morning: low
midday: high
evening: low
Winter: lower
summer: high
How has college students BP been declining even with weight rising?
Better prenatal care.
Dietary Fats reducing BP
Not really known about fully.
Indigenous people
95/60
-low salt, etoh, high exercise, low fat, small
Age affecting BP
75+ = 78% males and 75% females
35-44 = 16% males and 8% females
Ethnicity affecting BP
Maori and PI high (5-6) then european
Asian higher then european
Why are women more likely to get treated then men??
Because they are more likely to come in.
How is BP usually measured?
Screening in GP via
- mercury sphygomomanometer
- electronic in future
- wrist BP measure (same size)
Causes of BP
> 95% lifestyle
also
- kidney disease
- adrenal (3 hormones)
- co-arctation of the aorta (DA)
Diagnosis of BP
3 visits
average of last 2 BPs
if 180/105 see in few weeks
250/130 see later in day
Checking in physical exam
Coarctation of aorta: radiofemoral delay
Renal Bruit
Pulse for arrhythmias
BMI
Pulse/peripheral pulses
Investigation/other risk factors
Kidney function
Endocrine system, (Na+, K+)
Urine for albumin and cast
FBC for large red cells
GGT liver for signs of heavy alcohol intake
fasting glucose
cholesterol
chest x-ray, ECG, or ECHO
Who to treat?
BP >170/100
5 year risk >15%
What to get the patient to change!
Drug therapy easiest
Exercise
Smoking cessation!!
Diet change
salt reduction
Smoking =
adding 40kg
in terms of risk
