HT Flashcards
How diagnose ht?
• Elevated bp on 3 occasions at least 2 days apart
• if bp severely elevated, 3 readings at first visit and ensure cuff is right.
Systolic ≥ 140
Diastolic ≥ 90
Define mild ht
Systolic 140-159
Diastolic 90-99
Define moderate ht
Systolic 160-179
Diastolic 100-109
Define severe bp
Systolic ≥ 180
Diastolic ≥ 110
Baseline testing for ht? (4)
- urine protein by dipstick. If positive, send blood for creatinine and eGFR
- BMI for cv risk assessment
- abdominal circumference
- serum potassium concentration if on ace-i or eGFR <30
Six monthly monitoring for ht?
Serum potassium concentration if on spironolactone (K sparing diuretic) or eGFR <30
Annual monitoring for ht? (3)
- Fingerprick blood glucose
- Urine protein
- serum creatinine and eGFR in patients who have proteinuria, existing cv disease, ht for 10 years or more or uncontrolled, CKD eGFR < 60
Treatment for mild ht?
- If no cv risk factors, initiate lifestyle modification. If poor compliance after 3 months, initiate medicine
- if risk factors, medicine and lifestyle
Treatment for moderate ht?
- confirm diagnosis within 2 weeks
* initial treatment after confirm diagnosis- lifestyle and hydrochlorothiazide
Treatment for severe HT?
Confirm diagnosis within 1 hour
Initiate third line treatment if. not symptomatic- lifestyle, hctz, CCB or ace-i
If symptoms , hypertensive urgency/emergency
Follow up in 1 week
Refer if bp > 160/100 after 4 weeks
First line treatment ht?
Lifestyle modification.
Second line treatment ht?
Lifestyle
And
Ace-i eg enalapril 10 mg
Third line treatment ht?
Lifestyle and Ace-i eg enalapril 10 mg
Hctz 12,5 mg, or
Long acting CCB eg amlodipine 5mg or
Fourth line treatment ht?
- Lifestyle and
- Hctz 12,5 mg and
- increase dose of drug added in third line eg increase amlodipine from 5 to 10 mg or enalapril from 10 to 20 mg
Fifth line treatment ht?
- Lifestyle and
- hctz 12,5 mg and
- ace-i 10 mg if not started in 4th line, otherwise continue 20 mg
- amlodipine (CcB) continue 10 mg from step four, otherwise start 5 mg
Sixth line treatment ht?
• Lifestyle and
• hctz 12,5 mg
• ace-i eg enalapril 20 mg
. CCB eg amlodipine 10 mg
Seventh line treatment ht?
• Lifestyle and • hctz 12,5 mg • ace-i eg enalapril 20 mg . CCB eg amlodipine 10 mg and • spironolactone 25 mg If still not controlled refer
Contraindication spironolactone and why?
Kidney failure eGFR <30
Pregnancy
Can cause severe hyperkalaemia and should only be used when serum potassium can be monitored, do not use with potassium supplements
Name 4 contraindications to hydrochlorothiazide
• Gout
• pregnancy
• severe liver impairment
. Kidney impairment eGFR <30
Name 6 contraindications to ace-i
• Pregnancy . Bilateral renal artery stenosis or stenosis of an artery to a dominant or single kidney • aortic valve stenosis • history angioedema • hyperkalemia • severe renal impair egfr <30
Common symptom of ace-i?
Angioedema
Contraindication to calcium channel blockers?
Untreated heart failure
Treatment of hypertensive emergency?
Amlodipine 10 mg stat oral
If pulmonary oedema, furosemide iv 40 mg as single dose
Refer immediately
Name 7 cardiovascular risk factors
- Hypertension
- family history premature cv disease (men < 55 years, women <65)
- history Tobacco smoking
- evidence overweight/obesity (BMI or waist circumference >102 cm in men and > 88 cm women)
- Dyslipidaemia (xanthoma, total cholesterol > 6,5 or LDL >4 or HDL <1 men <1, 4 women)
- Dm,
- Ages > 55 men > 65 women
Drugs of choice for angina and ht?
Beta blocker or CCB
Drugs of choice for Prior mi and ht?
Beta blocker and ace-i (ARB if tolerant)
Verapamil if beta blockers contraindicated
Define refractory hypertension
Not optimally controlled on 3 or more classes antihypertensives
Must exclude secondary causes and refer.
Which antihypentensive is renal protective?
Ace-i eg enalapril
Name complications /symptoms associated with hypertensive emergency (6)
- Ht encephalopathy (severe headache, visual disturbance,confusion, seizures,coma)
- unstable angina /mi
- acute lv failure, pulmonary oedema
- eclampsia, severe pre-eclampsia
- acute aortic dissection
- AKI
