HTN Flashcards
How does NICE define HTN?
- Clinic reading persistently >=140/90 mmHg
- 24 hr BP average >=135/85 mmHg
According to NICE guidance how do you investigate and diagnose HTN in primary care?
- Measure BP in both arms
- If >140/90 repeat
- Use the lower of both readings
- If >=140/90 offer ABPM/HPBM
- Diagnose HTN if average >=135/85
Diagnosing HTN:
1. What do you do if someones BP varies between arms?
2. What is a pathological cause of this?
- If difference >20, repeat. If remains >20, subsequent BP should be recorded from arm with the higher reading
- Supravalvular aortic stenosis
What is accelerated HTN/hypertensive emergency?
Severe HTN (often >220/120) with signs of end organ damage
What clinic and ABPM/HBPM readings indicate
1. Stage 1 HTN
2. Stage 2 HTN
3. Severe HTN
- > = 140/90 and subsequent average >= 135/85
- > = 160/100 and subsequent average >= 150/95
- Clinic systolic >= 180 or diastolic >= 120
What do you do if someones BP in clinic >=180/120?
- If signs of retinal haemorrhage/papilloedema -> admit
- If new onset confusion, chest pain, signs of HF, AKI -> admit
- If none of the above -> arrange urgent investigation for end-organ damage
How do you check for end organ damage?
- Fundoscopy - hypertensive retinopathy
- Urine dip - renal disease
- ECG - LV hypertrophy/IHD
What are signs/symptoms of hypertension?
- Headaches
- Visual disturbances
- Seizures
What is the management of ABPM/HBPM >=135/85?
Offer drug treatment if <80 AND any of…
- Target organ damage
- Establish CVD
- Renal disease
- DM
- QRISK >10%
What is the management of ABPM/HPBM >=150/95?
Offer drug treatment regardless of age
What is the management of HTN in patients <55 or with a background of T2DM? Give the 1st, 2nd and 3rd line treatment options.
- ACE-In/ARB
- Add CCB
- Add thiazide-like diuretic
What is the management of HTN in patients >=55 or of black African or African-Caribbean origin? Give the 1st, 2nd and 3rd line treatment options.
- CCB
- Add ACE-In/ARB (ARB if black African or African-Carribean)
- Add thiazide-like diuretic
What are the 4th line treatment options for HTN?
- If K+ <4.5mmol/l add spironolactone
- If K+ >4.5mmol/l add alpha/beta blocker
What thiazide-like diuretic is NOT used to treat HTN?
Bendroflumethiazide
Side effects of ACE inhibitors?
- Dry cough
- Angioedema
- Hyperkalemia
Side effects of ARBs?
- Dizziness
- Hyperkalemia
Side effects of CCBs?
- Dizziness
- Swollen ankles
- Constipation
- Facial flushing
Side effects of thiazide diuretics?
- Dehydration
- Hyponatraemia
- Hypokalaemia
Side effects of beta blockers?
- Cool hands and feet
- Poor sleep
- Impotence
What should you tell patients with HTN worried about their medication causing impotence?
High BP is a RF for impotence as it leads to narrowing of arteries which reduces blood flow to the penis
What age is used to guide HTN management?
55
What are clinic BP targets if…
1. Age <80
2. Age >80
- 140/90
- 150/90
