FN: Hypertension Flashcards
Definitions of Hypertension
Stage 1: Clinic BP >140/90
Stage 2: Clinic BP > 160/100
Severe: ClinicBP > 180/110
Malignant hypertension
BP > 180/110 + papilloedema and/or retinal haemorrhage
Isolated SHT
SBP > 140
DBP <90
Aetiology: PREDICTION
Primary: 95% Renal: RAS, GN, APKD, PAN Endo: increased T4, Cushings, phaeo, acromegaly, Conn's Drugs: cocaine, NSAIDs, OCP ICP increase CoA Toxaemia of regnancy (PET) Increased viscosity Overload with lfuid Neurogenic: diffuse axonal injury, spinal section
End-organ damage: CANER
Cardiac:
- IHD
- LVH - CCF
- AR, MR
Aortic:
- Aneurysm
- Dissection
Neuro:
- CVA: ischaemic, haemorrhagic
- Encephalopathy (malignant HTN)
Eyes: hypertensive retinopahty
Renal:
Proteinuria
CRF
Eyes: Hypertensive retinopthy classification
Keith-wagener Classification
- Toruosity and silver wiring
- AV nipping
- Flame haemorrhage and cotton wool spots
- Papilloedema
Grades 3 and 4 - malignant hypertension
Investigations
- 24h ABPM
- Urine: Haematuria, Alb: Cr ratio
- Bloods: FBC, U +Es, eGFR, glucose, fasting lipids
- 12 lead ECG: LVH, old infarct
- Calculate 10 yr CV risk
Management
Do ABPM o confirm Dx before Rx (unless severe HTN)
Lifestyle interventions
increase excercise
Decrease smoking, decrease EtOH, decrease salt, decrease caffeine
Indications for pharmacological treatment
20%
- Established CVD
- DM
- Renal disease
Anyone with stage 2 HTN (>160/100)
Severe/ malignant HTN (specialist referral)
Consider specialist opinion if <40 yrs with stage 1 HTN and no end organ damage.
BP targets
Under 80yrs <150/90
CV risk Management
Statins indicated for primary prevention if 10 yr CVD risk >20%
Aspirin may be indicated: evaluate risk of bleeding
Malignant HTN
Controlled reduction in BP over days to avoid stroke
Atenolol or long-acting CCB PO
Encephalopathy/CCF: fruse + nitroprusside/labetalol IV
1. aim to reduce BP to 110 diastolic over - 4h
2. Nitroprusside requires intra-arterial BP monitoring
