Hypertension Flashcards
1
Q
ESSENCE
A
High blood pressure
>140/90 in clinic or 135/85 with ambulatory or home readings
2
Q
AETIOLOGY
A
- Essential hypertension (primary hypertension) accounts for 95% and is idiopathic
- Secondary causes remember ROPE
- Renal disease
- Obesity
- Pregnancy induced/pre-eclampsia
- Endocrine
3
Q
Most common cause of secondary hypertension
A
Renal disease
4
Q
What cause should be considered if BP very high or dose not respond to treatment
A
Renal artery stenosis
5
Q
Most common endocrine cause
A
Hyperaldosteronism (Conns syndrome)
Simple test for is renin aldosterone ratio test
6
Q
COMPLICATIONS
A
- Ischaemic heart disease
- Cerebrovascular accident (i.e. stroke or haemorrhage)
- Hypertensive retinopathy
- Hypertensive nephropathy
- Heart failure
7
Q
Drug incuded causes of hypertension
A
- Oral contraceptives
- Glucocortocoids
- Phenylephrine
- NSAID
8
Q
CLINICAL FEATURES
Presentation
A
- Asymptomatic until complications develop
- Complications present with
- Shortness of breath
- Chest tightness
- Headache
- Vision changes
9
Q
CLINICAL FEATURES
Signs
A
- Displaced PMI
- Retinal changes
- A/V nipping and copper wire changes to arterioles
- Papilledema and retinal haemorrhages
- Systolic ejection click
- Loud S2
- Possible S4
10
Q
DIAGNOSIS
A
- Screening every 5 years, more often patients that are borderline and every year in T2 diabetes
- If clinic BP >140/90 should have 24h ambulatory BP monitoring to confirm diagnosis
- Avoid white coat syndrome
11
Q
STAGES
A
- Stage 1
- Clinic reading >140/90 or ambulatory >135/85
- Stage 2
- Clinic reading >160/100 or ambulatory >150/95
- Stage 3
- >180/120
12
Q
INVESTIGATIONS
A
- 24h ambulatory BP - confirm diagnosis
- Assess for end stage organ damage
- Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria
- Bloods - HbA1c, renal function and lipids
- Fundus examination - hypertensive retinopathy
- ECG - cardiac abnormalities
13
Q
Medications used for management
A
- Remember A B C D ARB
- ACE inhibitor
- Beta blocker
- Calcium channel blocker
- thiazide like Diuretic
- Angiotensin II Receptor Blocker
14
Q
What should be noted about ARBs
A
- Used in place of ACE inhibitor when they not tolerated (commonly due to dry cough)
- Or if patient is black of African or Afro-carribean descent
- Cannot be used together with ACE inhibitor
15
Q
MANAGEMENT
Initial
A
- Establish diagnosis
- Investigate for end stage organ damage
- Advice on lifestyle
- Possible next line of medical management
