Hypertension Flashcards
What is this describing?
BP >140/90mmHg, with no secondary cause identified.
Essential (primary) hypertension (95%)
What are the causes of secondary hypertension?
- Renal disease (75%) - glomerulonephritis, renal artery stenosis, chronic pyelonephritis, polycystic kidneys.
- Endocrine disease - Cushing’s, Conn’s, phaeochromocytoma, acromegaly
- Others - steroids, COCP, pregnancy, coarctation of the aorta, systemic sclerosis.
What is this describing?
BP >200/130mmHg and end organ damage.
Malignant hypertension
What are the complications of malignant hypertension?
- Bilateral retinal haemorrhage
- Headaches, visual disturbances
- AKI, HF, encephalopathy, stroke, seizures
What causes malignant hypertension?
Renovascular disease - breakdown of autoregulation and failure to protect microcirculation from high pressure.
What is this describing?
Elevated clinic blood pressure but normal daily average.
White Coat hypertension
What are the risk factors for developing hypertension?
Obesity, aerobic exercise <3x per week, moderate/high alcohol, metabolic syndrome, diabetes, black ethnicity, >60 years old, family history of hypertension or coronary artery disease, sleep apnoea.
What are the six main effects of hypertension?
- Accelerates atherosclerosis and arteriosclerosis
- Hypertensive heart disease
- Hypertensive renal disease
- Retinal changes
- Aortic dissection
- Intracerebral haemorrhage
What is arteriosclerosis?
Hardening of an artery or arteriole.
What are the two types of arteriosclerosis that hypertension can predispose to?
- Hyaline - gradual, smooth muscle replaced by collagen, decreased arterial compliance, age-related BP change, makes hypotension more dangerous
- Hyperplastic - characteristic of malignant hypertension
How does hypertension cause heart disease?
- Coronary artery atherosclerosis accelerated (IHD)
- Left ventricle pushes harder against high pressure and undergoes hypertrophy.
- Increased metabolic demands of myocardium which the heart cannot make.
- Eventual decompensation and failure.
How does hypertensive heart disease manifest?
MI, arrhythmias (AF), progressive left heart failure.
How does hypertension cause renal disease?
- Hyaline arteriosclerosis in renal arterioles causes chronic and progressive renal ischaemia.
- Tubular atrophy, intestinal fibrosis and progressive glomerular sclerosis = CKD.
What would a kidney USS show in hypertensive renal disease?
Small kidneys with atrophy and fibrosis.
What are the retinal changes seen in hypertension?
Flame haemorrhages, hard exudates, cotton wool spots and papilloedema.
How does hypertension cause intracerebral haemorrhage?
- Haemorrhagic - rupture of tiny Charcot-Bouchard aneurysms which form in weakened arterioles.
- Ischaemic - HTN accelerates atherosclerosis
- SAH - rupture of berry aneurysms
What should you offer in these situations?
- Clinic BP reading >140/90mmHg
- Clinic BP reading >160/110mmHg
- Offer ambulatory BP monitoring, calculate CV risk and look for organ damage.
- Offer treatment
What ambulatory BP monitoring results would prompt you to offer a patient treatment for hypertension?
- > 135/85mmHg - treat if CV risk >20%/10 years OR end organ damage/DM/renal disease
- > 150/95mmHg - treat regardless of age
Bedside tests, blood tests, and imaging should you consider in hypertension as well as BP monitoring?
- Bedside tests - BP monitoring, urinalysis (proteinuria), ECG
- Blood tests - U&Es (exclude secondary causes), K+, eGFR, fasting glucose, cholesterol.
- Imaging - echo (LVH in end-organ damage)
What is the target BP in the treatment of hypertension?
- <140/90mmHg
2. <130/80mmHg in DM if end organ damage
Why should you reduce BP slowly in hypertension management?
To reduce stroke risk
What lifestyle changes should be suggested when treating hypertension?
Smoking cessation, low fat diet, reduce alcohol and salt intake, exercise, weight loss if obese.
How often should you check BP while initiating treatment of hypertension?
Every 2-4 weeks
What is the first step of medical treatment of hypertension for these groups?
- <55 years
- 55 years or older, or Afro-Caribbean origin
- ACEi
2. Calcium channel blocker
What is the second step of medical treatment of hypertension?
ACEi and Calcium channel blocker
What is the third step of medical treatment of hypertension?
ACEi, calcium channel blocker and thiazide diuretic
What is the fourth step of medical treatment of hypertension?
- If K+ <4.5 = add spironolactone
- If K+ >4.5 = add higher dose thiazide diuretic
- If further diuretic therapy not tolerated = alpha/beta-blocker.
