Evidence based medicine for treatment of hypertension Flashcards
what is an NHS health check
- a health check for adults in England aged 40-74
2. designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes, or dementia
what information is gathered during an NHS health check
- family history, smoking, drinking, physical activity
- weight and height
- age, gender and ethnicity
- blood pressure and pulse taken
- blood test to check cholesterol and blood sugar level
what symptoms may occur in high blood pressure
- headaches, dizziness, recurrent epistaxis, palpitations, sweating, weight and hair loss
- or may be asymptomatic
what is ambulatory blood pressure monitoring
- takes blood pressure every 30 minutes
- need at least 14 daytime readings for diagnosis
- mean daytime blood pressure
what is home blood pressure monitoring
- alternative to ABPM
- at least 4 days and ideally 7 days
- 2 readings morning and 2 readings evening at least 1 minute apart
- discard day 1 readings and then average blood pressure from all other days
what are the top tips for taking blood pressure
- patient needs to be relaxed
- take the pulse for 1 minute
- arm should be supported at heart level
- the correct cuff should be used
- no talking
- back supported, feet lat on floor
- take 2 readings
- use the same arm for blood pressure monitoring
what are the consequences of high blood pressure
could lead to:
- organ damage
- stroke
- heart failure
- vision loss
- heart attack
- kidney disease
describe the investigation for target organ damage and to establish CV risk
- urinalysis for blood and protein
- renal function- blood test
- electrolytes- blood test
- HbA1c- blood test
- lipid profile- blood test
- TFT and LFT
- ECG
- eyes- optician
what is the QRISK3 risk calculator
- calibrated for UK population
- calculates risk of having a heart attack or stroke over next 10 years
- based on data from GPs
- annually updated to remain accurate - this is for a primary prevention patient
what is primary prevention of hypertension
90-95%
- no identifiable cause
what is secondary prevention of hypertension
5-10%
- cause identified
- often rapid progression with very high blood pressure
give examples of ace inhibitors and when they would be used
- enalipril, ramipril
- first line in younger caucasian patients
- diabetics
- primary and secondary prevention of CVD
- heart failure
what cautions should be taken with use of ace inhibitors
- avoid k+ sparing diuretics and NSAIDs
- care with diuretic therapy
- caution with aortic stenosis
- contraindications include bilateral renal artery stenosis
- don’t use in pregnancy
give examples of ARBs and when they are used
- candesartan, losartan
- an alternative to ace inhibitor
- for black patients of African or Caribbean origin
- lower risk of angio oedema
give examples of dihydropyridine calcium channel blockers and when they are used
- amlodipine, nifedipine
- vasodilation of coronary and peripheral arteries and relax vascular smooth muscle
- also used in treatment of stable angina