Hypertension Flashcards
Diagnosis of hypertension
a) stage 1
b) stage 2
c) severe hypertension
a) clinic BP >140/90 and subsequent ABPM >135/85
b) clinic BP >160/100 and subsequent ABPM >150/95
c) clinic systolic BP >180 or diastolic BP >110
If clinic BP indicates severe HTN, how should this be managed?
Consider starting antihypertensive treatment without waiting for ambulatory values
How should patients be advised to provide home readings?
Measure BP on 7 consecutive days; take 2 readings > 1 min apart, morning and night; discard the first day values and calculate average of the remaining values
When should patients with stage 1 hypertension be considered for drug treatment?
If younger than 80 + one of: target organ damage established CVD renal disease DM >10% 10yr risk
Step 1 hypertension management (2)
<55 years of age- ACE inhibitor/ARB if not tolerated
>55 years of age/Black/AfroCaribbean- calcium channel blocker or thiazide-like diuretic
Step 2 hypertension management
ACE/ARB + Ca blocker/thiazide
Step 3 hypertension management (2)
Ensure step 2 management is at optimal/best tolerated dose
ACE/ARB + Ca blocker + thiazide-like
Stage 4 hypertension management (3)
Consider further diuretic e.g. spironolactone 25mg od if K <4.5, increase thiazide if K >4.5
Consider alpha or beta blocker
Consider specialist referral
When should patients be reviewed?
1 month after starting treatment
3/6 months once controlled then annually
Blood pressure target- non diabetic patient without CKD
Clinic- <140/90 (150/90 if aged above 80)
Ambulatory <135/85
Blood pressure target
a) uncomplicated T2DM
b) uncomplicated T1DM
c) any renal/foot/eye/CV complications of diabetes
a) <140/80
b) <135/85
c) <130/80
Blood pressure target
a) CKD
b) CKD + DM
a) <140/90
b) <130/80
Blood pressure target- proven carotid stenosis
140-150 systolic
