GP Cardiology Flashcards
Define Stage 1 Hypertension?
Clinic Reading: 140/90 to 159/99
ABPM/ HBPM: 135/85 to 149/94
Definition of Stage 2 hypertension?
Clinic Reading: 160/100 to < 180/120
ABPM/ HBPM Reading: 150/95 to <180/120
Define Stage 3 hypertension?
Clinic Reading: systolic over 180 or diastolic over 120
Risk factors for developing primary hypertension?
• Increasing age
• Family history
• Physical inactivity
• Male
• Obesity
• Diet high in fats and salts
• Excessive alcohol intake
• African American Descent
What should happen on initial diagnosis of hypertension?
All patients diagnosed with hypertension should have their cardiovascular risk assessed using an appropriate calculator (NICE recommend QRISK)
In all patients with hypertension offer to:
1. Send a urine sample to test for albumin: creatinine ratio and test for haematuria using a reagent strip
2. Take a blood sample to measure HbA1c, electrolytes, creatinine, eGFR, total cholesterol and HDL cholesterol
3. Examine fundi for evidence of hypertensive retinopathy
4. Arrange for 12 lead ECG to be performed
Management of hypertension?
All patients should be given lifestyle advice
Who should start anti-hypertensive treatment?
- Adults of any age with persistent stage 2 hypertension
- Consider it in those under 80 with stage 1 who have target organ damage, established CVS disease, renal disease, diabetes or an estimated 10 year cardiovascular disease risk of 10% or more
Describe the pathway for pharmacological management of hypertension?
STEP 1:
For patients under 55 start an ACE-inhibitor or an ARB
For patients over 55 or black African or Caribbean patients of any age start a calcium channel blocker (CCB)
STEP 2:
Add the other one
STEP 3:
Add a thiazide diuretic
STEP 4:
At this point you definitely want specialist advice
Will probably add more diuretic or an alpha or beta blocker, may consider spironolactone
