GP ILAs Flashcards
What is needed to confirm a diagnosis of Hypertension
24hr ABPM or a week of at home readings
At what BP reading should treatment be offered
all with BP ≥160/100mmHg or ABPM ≥150/95mmHg.
Health conditions which can cause hypertension
- Kidney disease/long term infections
- Diabetes
- Glomerulonephritis
- Hormone issues- underactive thyroid, Cushing’s, Acromegaly, hyperaldosteronism, phaechromocytoma
Medications which can cause hypertension
- contraceptives
- steroids
- NSAIDs
- Cocaine/amphetamines
- Some SSNRIs e.g. venlafaxine
How can hypertension affect the kidney?
○ People with hypertension and normal kidney function have a significantly reduced number of nephrons in each kidney
○ Individual nephrons are enlarged as a result of glomerular hyperfiltration
what tests are used to quantify overall risk of a hypertension diagnosis?
fasting glucose and cholesterol
what tests are used to look for end-organ damage from hypertension
- ECG/Echo (LVH or history of MI?)
- Urine analysis (protein, blood)
What test can exclude secondary causes of hypertension
Bloods- U&E: decreased K+ in Conn’s, increased Ca2+ in hyperparathyroidism
Explain pathophysiology of essential hypertension
Primary (essential hypertension): arteriosclerosis of major renal arteries, and changes in intrarenal vasculature (nephrosclerosis)
- blood vessel wall becomes hyalinised in small vessels and arterioles as the intima thickens with reduplication of the internal elastic lamina
- Concentric reduplication of internal elastic lamina and endothelial proliferation lead to ‘onion skin’ appearance
- both kidneys reduce in size- can be asymmetrical if one major vessel is affected
- proportion of sclerotic (scarred) glomeruli increases
What is the range for stage 1 Hypertension
a systolic BP of 130-139 or a diastolic BP of 80-89
What is the range for stage 2 hypertension
systolic>140, diastolic>90
is the cause of essential (primary) hypertension known or unknown?
unknown
what percentage of hypertension cases are secondary hypertension and what is secondary hypertension?
5% . Secondary Hypertension= Hypertension with an identifiable cause i.e. secondary to another condition.
what are some causes of secondary hypertension?
- renal disease (intrinsic issues such as glomerulonephritis, systemic sclerosis and PCKD & renovascular diseases which are usually atheromatous)
- Endocrine disease e.g. Cushing’s, Conn’s, Phaechromocytoma, Acromegaly, Hyperparathyroidism
- coarctation, pregnancy, drugs (steroids, oral contraceptive, cocaine, amphetamines)
Treatment pathway for a patient with type 2 diabetes diagnosed with hypertension? (4 steps)
(1) ACEi/ARB
(2) (ACEi/ARB) + CCB/thiazide-like diuretic
(3) ACEi/ARB + CCB + thiazide-like diuretic
(4) Confirm resistant hypertension and consider seeking expert advice or adding a low-dose spironolactone if blood potassium level is ≤4.5mmol/l OR an alpha-blocker/beta-blocker if potassium level is >4.5mmol/l
Treatment pathway for patient <55, not of black/afro-Caribbean descent and with no diabetes who is diagnosed with hypertension? (4 steps)
(1) ACEi/ARB
(2) (ACEi/ARB) + CCB/thiazide-like diuretic
(3) ACEi/ARB + CCB + thiazide-like diuretic
(4) Confirm resistant hypertension and consider seeking expert advice or adding a low-dose spironolactone if blood potassium level is ≤4.5mmol/l OR an alpha-blocker/beta-blocker if potassium level is >4.5mmol/l
Treatment pathway for patient age 55 or over with no diabetes?
(1) CCB
(2) (CCB) + ACEi/ARB/thiazide-like diuretic
(3) ACEi/ARB + CCB + thiazide-like diuretic
(4) Confirm resistant hypertension and consider seeking expert advice or adding a low-dose spironolactone if blood potassium level is ≤4.5mmol/l OR an alpha-blocker/beta-blocker if potassium level is >4.5mmol/l
Hypertension treatment algorithm for patient with black african or afro-caribbean family origin (any age)?
(1) CCB
(2) (CCB) + ACEi/ARB/thiazide-like diuretic
(3) ACEi/ARB + CCB + thiazide-like diuretic
(4) Confirm resistant hypertension and consider seeking expert advice or adding a low-dose spironolactone if blood potassium level is ≤4.5mmol/l OR an alpha-blocker/beta-blocker if potassium level is >4.5mmol/l
How often should patients with hypertension be monitored:
1- adjusting their hypertension medication
2-once stabilised
3- serum potassium and creatinine
1- when adjusting medication BP should be monitored every 2-4 weeks
2- Once stabilised, BP should be checked and medications reviewed every 6-12 months
3- Serum Potassium and Creatinine should be checked yearly
What are the 3 most likely complications of hypertension?
Coronary artery disease, cerebrovascular accidents (e.g. stroke) and Left Ventricular Hypertrophy
hypertension medications which can result in erectile dysfunction
thiazide-like diuretics and beta blockers
hypertension medication which results in ankle swelling
calcium channel blockers
hypertension medications which result in dry cough
ACE inhibitors e.g. ramipril
Most common cause of HF in the developed world
Ischaemic heart disease