Essential or secondary hypertension Flashcards
NICE definition of HTN
Clinic reading persistently >140/90
24 hour reading >135/85
Primary/ essential HTN
No single disease causing the rise in BP
Complex physiological changes which occur with age
Secondary HTN
Caused by a wide range of endocrine, renal and other causes
Renal causes of HTN
Glomerulonephritis
Chronic pylenonephritis
Adult polycystic kidney disease
Renal artery stenosis
Endocrine causes of HTN
Primary hyperaldosteronism
Phaeochromocytoma
Cushing’s syndrome
Liddle’s syndrome
Congenital adrenal hyperplasia
Acromegaly
Other causes of HTN
Glucocorticoids
NSAIDs
Pregnancy
Coarctation of the aorta
COCP
Symptoms
Typically no symptoms unless BP very high
Headaches, visual disturbances, seizures
Complications of HTN
IHD
Cerebrovascular accident
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure
Assessing end-organ damage
Fundus examination for retinopathy
Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria for nepthropathy
Bloods for HbA1c, renal function and lipids
ECG for cardiac abnormalities
Medical management step 1
Aged <55 and non-black use ACEi
Aged >55 or black of African or African-Caribbean descent use calcium channel blocker
Step 2
ACEi and CCB or thiazide like diuretic OR
CCB and ACEi/ARB or thiazide like diuretic
If black then use ARB instead of ACEi
Step 2
ACEi and CCB or thiazide like diuretic OR
CCB and ACEi/ARB or thiazide like diuretic
If black then use ARB instead of ACEi
Step 3
ACEi/ARB + CCB + thiazide like diuretic
STep 4
Same as three plus an additional agent
K+<4.5 use potassium sparing diuretic
K+>4.5 use an alpha blocker or beta blocker
Treatment targets
<80 aim for <140/<90
> 80 aim for <150/<90
