HTN Flashcards
What are the two main types of HTN?
Essential HTN and Secondary HTN
What is the BP cut off for essential HTN?
≥140/90 mmHg
What is isolated systolic HTN and what demographic is it most commonly found in?
A BP >140/90 mmHg. Common in the elderly, it is caused by an age-related gradual reduction in the compliance of vessels
What is the difference between essential/primary and secondary HTN? Which is more common?
Essential has a generally unknown aetiology, whereas secondary has an underlying cause and is considerably rarer, constituting roughly 5% of cases
What is the BP cut off for accelerated and malignant HTN?
> 180/120 mmHg
What is accelerated HTN?
A critically elevated BP >180/120 mmHg with target organ damage. Typically only has cardiovascular complications
What is malignant HTN?
A critically elevated BP >180/120 mmHg with cardiovascular and neurological complications
What are the main causes of Secondary HTN?
REPMD Renal artery stenosis Endocrine Pre-eclampsia Mechanical - coarctation of the aorta Drugs - cocaine
What are the endocrine causes of secondary HTN?
Cushing's syndrome Hyperthyroidism Conn's syndrome Pheochromocytoma Acromegaly
When do you suspect secondary HTN?
Young (<40) Refractory to treatment Signs and symptoms of causes - e.g. cushingoid appearance Accelerated HTN Abrupt changes in BP No FHx
How do you diagnose HTN?
If BP ≥140/90 then take a second reading. If this is also high, take a 3rd and record the last two measurements.
Then do ABPM (24hr reading) - if unsuitable, HBPM
What score can you assess HTN patients for to estimate CV risk?
QRISK score
What are the two stages of essential HTN?
Stage 1: ≥135/85-149/94
Stage 2: ≥150/95
What red flags on assessment would require urgent hospital admission for a hypertensive crisis?
Flame haemorrhages on the retina
Papilloedema
Suspected pheochromocytoma
What are the management options for HTN? How does the pharmacological management progress?
Lifestyle management
Pharmacological:
- 1st line: ACEI/ARB if <55; CCB if >55 and Black
- 2nd line: ACEI/ARB + CCB or Thiazide; CCB + ARB or Thiazide
- 3rd line: All 3 drugs
- 4th line: consider adding K+ sparing diuretic, Beta Blocker, or Alpha Blocker. Also consider specialist advice/referral
