Diagnosis Flashcards
What is HTN a risk factor for?
- Stroke
- IHD
- HF
- CKD
- Cognitive decline
- Premature death
When would you measure BP manually?
if pulse irregularity is present
When would you take a second BP measurement?
- If the difference in readings between arms is more than 15 mmHg
- If BP measured in the clinic is 140/90 mmHg or higher
Which measurements of BP do you record?
The lowest 2
When would you offer ABPM or HBPM?
Patient’s BP is between 140/90 mmHg and 180/120 mmHg
When using HBPM, what is the advice given?
- Stay seated
- Take 2 consecutive measurements, as least 1 minute apart
- Record in the morning and at night
- Want 14 measurements (7 days)
How would you diagnose HTN from HBPM?
Discard the measurements taken on the first day and use the average value of all the remaining measurements
What is a diagnosis of HTN?
• Clinic BP of 140/90 mmHg ≥
AND
• ABPM or HBPM average of 135/85 mmHg ≥
What tests would you offer to a patient with newly diagnosed HTN?
- Urinalysis
- HbA1C, U+Es, creatinine, eGFR, total cholesterol and HDL cholesterol
- Fundoscopy
- ECG
What are the clinic BP aims?
- <80 = ≤ 140/90 mmHg
* >80 = ≤ 150/90 mmHg
What are the BP aims for ABPM and HBPM?
- <80 = <135/85 mmHg
* >80 = <145/85 mmHg
What are the stages of HTN?
STAGE 1
135/85 - 149/94
STAGE 2
150/95 - 179/119
STAGE 3
>180/120
What is a hypertensive urgency?
BP is >180/110
No acute damage to kidneys, heart or brain
What is a hypertensive emergency?
BP is >180/120
Damage to end organs
What are the symptoms of a hypertensive urgency?
o Severe headache
o SOB
o Epistaxis
o Anxiety
What are the symptoms of a hypertensive emergency?
o Chest pain o SOB o Back pain o Numbness and weakness o Changes in vision o Difficulty speaking o Encephalopathy
How would you manage a hypertensive emergency?
IV meds:
- Vasodilator
- CCB
- Beta-blocker
Who is at most risk of heart disease and stroke?
- CKD 3, 4, 5
- Migraine
- Corticosteroids
- Systemic lupus erythematous (SLE)
- Atypical antipsychotics
- Severe mental illness
- Erectile dysfunction
- A measure of systolic BP variability
What is a Q-RISK3 score?
Identifies who is at most risk of heart disease and stroke
What Q-RISK3 score is the treatment threshold for prevention of CVD?
10%
In which patients would you not use a Q-RISK3 score?
- T1DM
- eGFR <60
- Albuminuria
- Familial hypercholesterolaemia
What advice should you give for prevention of CVD?
- Eat a cardioprotective diet
- At least 150 mins of moderate or 75 mins of vigorous intensity exercise per week
- Reduce alcohol consumption
- Smoking cessation
- Treatment with statins
What lipid measurements would you take to assess for CVD?
- Total cholesterol
- HDL cholesterol
- Non-HDL cholesterol
- Triglyceride concentrations
When would you consider the possibility of familial hypercholesterolaemia?
- Total cholesterol conc >7.5mmol/l and
* Family Hx of premature coronary heart disease
What treatment would you give for primary prevention of CVD?
• 20mg atorvastatin o.n.
Who would you give primary prevention treatment to for CVD?
- Patients that have not have CV disease in the past
- 10% or greater 10-year risk of developing CVD
- Have CKD or T1DM for >10yrs
What do you check after giving primary prevention for CVD?
Lipids
- 3 months
- Aim for >40% reduction in non-HDL cholesterol
LFTs
- 3 months, 12 months
- Need to stop if AST and ALT rise 3X above upper limit of normal
Who would you give secondary prevention to for the treatment of CVD?
Patients that have had angina, MI, TIA, stroke or peripheral vascular disease
What treatment would you give for secondary prevention of CVD?
• 80mg atorvastatin o.n.
What are the side-effects of statins?
- Myopathy
- T2DM
- Haemorrhagic stroke
For a hypertensive emergency, when would you use Nitroglycerin (GTN) IV?
If patient has co-existant coronary ischaemia or HF
Who would you NOT give labetalol to for a hypertensive emergency?
- Asthma
- Metabolic acidosis,
- Phaeocromocytoma
- Angina
- AV block
- HF
Why should you lower the BP gradually most of the time in a hypertensive emergency?
Ischaemic damage may occur in organs that have become accustomed to higher pressures (due to ‘autoregulation’).
An excessive hypotensive response is potentially dangerous, and may lead to ischaemic complications such as stroke, myocardial infarction, or blindness.
How much should you normally reduce the BP by in a hypertensive emergency?
20% in first hour
5-15% over next 23 hours
When would you lower the BP rapidly in a hypertensive emergency?
Aortic dissection
When would you not lower the BP in a hypertensive emergency?
Acute phase of ischaemic stroke
Not lowered unless >185/110 mmHg
