CVS Flashcards
How is hypertension diagnosed?
24 hour ABPM
What are the values for stage 1 HTN?
Clinic reading: 140/90 – 159/99
ABPM: 135/85 – 149/94
Stage 2 HTN values
Clinic reading: 160/100 -180/120
ABPM: (>150/95)
Stage 3 HTN values
Clinic reading: >180/120
What are the next steps if clinic reading is >140/90 mmg?
Offer ABPM or HBPM then:
- if > 135/85 mmg - Diagnose stage 1 HTN + treat if:
- < 80 years
- target organ damage
- established cardiovascular disease
- renal disease
- diabetes
- a 10-year cardiovascular risk equivalent to 10% or greater - if > 150/95 mmHg - Stage 2 HTN + treat all ages
What are the next steps if BP is >180/120?
admit for specialist assessment if:
signs of retinal haemorrhage or papilloedema (accelerated hypertension)
- life-threatening symptoms such as: new-onset confusion, chest pain, signs of heart failure, or acute kidney injury
If none of the above:
- Arrange urgent investigations for end-organ damage
What do you do if pt < 40 years old had HTN?
Exclude secondary causes
1st line management for HTN
Patients < 55 or T2DM:
ACEi or ARB
Patient > 55 or Black:
CCB
2nd line for HTN
If already on ACEi or ARB
- Add CCB or thiazide like diuretic
If already on CCB:
ACEi or ARB or thiazide like diuretic
3rd line for HTN
ACEi or ARB + CCB + thiazide-like diuretic
4th line for HTN
Resistant HTN:
K+ < 4.5 = add low-dose spironolactone
K+ > 4.5 = add alpa or beta blocker
BP target for < and > 80 years old
< 80 year = 135/85
> 80 year = 145/85
What is isolated systolic HTN?
Systolic blood pressure rises, but your diastolic blood pressure stays normal - 160 mmHg or more.
1st line for isolated systolic HTN
thiazides
Secondary causes of HTN
Renal diseases:
- glomerulonephritis
- pyelonephritis
- Renal artery stenosis
Endocrine:
- phaechromocytoma
- Cushing’s syndrome
Drugs:
- steroid
- COCP
Other:
- pregnancy
What is malignant HTN?
EMERGENCY
>180/120 w/ signs of retinal haemorrhage, papilledema – target organ damage
Orthostatic/postural hypotension
a drop in BP (usually >20/10 mm Hg) within three minutes of standing
Treatment for Orthostatic/postural hypotension
- fludrocortisone (increases blood volume)
- Midodrine (causes vasocontriction)
How is end organ damage assessed?
Fundoscopy: check for retinopathy
Urine dipstick: renal disease as a cause or consequence of HTN
ECG: left ventricular hypertrophy or ischaemic heart disease
What might you see in an ECG in someone who has postural hypotension?
prolonged QT, bundle branch block
Sx with severe HTN
- headaches
- visual disturbances
- seizures
What tests do patients typically have following a diagnosis of hypertension?
- U&Es
- HbA1c
- Lipids
- ECG
- Urine dipstick
Treatment algorithm for HTN
1) <55yo/T2DM : ACEi/ARB
>=55yo or AfroCarribean : CCB
2) ACEi/ARB + CCB
3) ACEi/ARB + CCB + Thiazide-like diuretic
4) K+ <= 4.5 : low-dose spironolactone
K+ >4.5 : alpha/beta blocker
When is an ARB preferred over an ACEi?
patients of black African or African–Caribbean origin taking a CCB, if they require a second agent consider an ARB in preference to an ACEi