HTN Flashcards
in what patient populations is hypertension more common in?
advancing age,
women aged 65-74,
people of African origin
what are the complications of hypertension?
stroke, MI, heart failure, renal failure and dissecting aortic aneurysm
what sounds are you listening for when using a stethoscope to measure bp manually?
korotkoff
how many distinct korotkoff sound phases are there?
5
what produces korotkoff sounds?
blood pressure cuff changes the flow of blood through the artery
what should phase 1 korotkoff sound like?
1st sound heard
sharp tapping as cuff pressure released and provides systolic pressure reading
what should phase 2 korotkoff sound like?
swishing sound as blood flows through vessels as cuff is deflated
what does phase 3 korotkoff sound like?
thump sounds softer than phase 1 as blood flows through artery but cuff pressure inflated to occlude flow inside diastole
what does phase 4 korotkoff sound like?
soft muffled sound as cuff pressure released
what does phase 5 korotkoff sound like?
silence as cuff pressure released enough to allow normal blood flow
the point at which all sounds completely disappear is the X pressure?
diastolic
what is defined as stage 1 hypertension?
clinic reading 140/90 -160/100
stage 1 htn is a ambulatory daytime average of home bp monitoring of?
average 135/85 or higher
what is defined as stage 2 hypertension?
clinic BP 160/100 - 180/120
stage 2 htn is an ambulatory daytime average of home blood pressure average of ?
150/95 or higher
what does htn Tx aim to do?
reduce the risk of cardiovascular morbidity and mortality, by reducing BP
what algorithm is used to calculate an accurate assessment of cv risk as a guide to htn management and level of risk for patient and if and when pharmacological treatment is needed?
QRISK3
what does QRISK3 indicate?
persons risk of developing heart attack or stroke over next 10 years
true or false, QRISK3 prevents average risk of people with same risk factors as those entered for that person?
true
it is important that before adding an additional agent to control htn you ave tried the first agent to the maximal dose. What might prevent you from doing this?
SEs
What is the target clinic blood pressure for a 50 year old male with no other co-morbidities?
below 140/90
Why do blood pressure targets vary?
location
anxiety
stress
px characteristics
Why are ACE or ARBs not first line in people who are African or African-Caribbean family origin?
lower renin levels hence less of a response to drugs that act via RAS
Why is it specifically thiazide-like diuretics that are recommended for HTN and not loop diuretics like furosemide?
thiazide like act on dct where less filtered sodium reabs
loop act on ascending loh where more sodium reabs
more efficient water loss but short half life so not good for consistent sustained bp drop
what should be the next step if clinic bp is high?
offer ABPM/ HBPM
why should you palpate the radial/brachial pulse before measuring BP?
to see if there any irregularities in the heartbeat
What to do if you get irregularities in the heartbeat or bp readings
repeat the bp reading
what should you do if someone has postural dizziness?
measure bp sitting and standing
how long should you wait between bp readings?
at least 1 min
what could be a reason that someone under 40 has hypertension?
CKD
diabetic neuropathy
renal cell carcinoma
primary hyperaldosteronism
what should be investigated if someone is newly diagnosed with hypertension
organ damage (eye, kidney)
what tests are used to assess organ damage?
measure:
UACR (check protein in urine)
hbA1c (for diabetes)
elec, creat, eGFR (CKD assessment)
what things need to be investigated if someone has been diagnosed with hypertension?
CV risk - cholesterol, QRISK
assess organ damage
consider need for investigation if secondary htn suspected
when should you refer someone to a specialist same day service?
if clinic bp over 180/120 and signs of retinal haemorrhage or AKI and signs of hypertension
lifestyle advice for people with hypertension
healthy diet and regular exercise
reduce caffeine
reduce dietary sodium
smoking and alcohol
what antihypertensives are safe in pregnancy? 3
labetalol, methyldopa, nifedipine
why is the target bp higher for the elderly?
risk of oevrtreating and falls
why is the target BP lower for someone with diabetes
increased CV risk
when is ACEi/ ARB 1st line?
HTN w T2DM
OR
age<55 and non black african/ afro caribbean
when is CCB 1st line?
no T2DM but over 55 OR black african/ afro carribean
