Hypertension Flashcards
What BP value is defined as hypertension?
140/90 clinic or 135/85 ambulatory
What percentage of hypertension is primary?
95%
What are the causes of secondary hypertension? (ROPE)
- Renal disease
- Obesity
- Pregnancy
- Endocrine, most endocrine conditions cause hypertension
What test can be used to check if hypertension is caused by hyperaldosteronism?
renin:aldosterone ratio (blood test)
What are the common complications of hypertension?
- ischaemic heart disease
- Cerebrovascular accident
- hypertensive retinopathy
- hypertensive nephropathy
- heart failure
What is white coat syndrome?
higher than normal BP reading when in a doctors office due to stress of being there can increase by more than 20/10 mmHg
How often should someone without hypertensions BP be checked?
every 5 years
of at higher risk more often
If someone has a clinic blood pressure of above 140/90 mmHg what should be the next step in diagnosis?
24 hour ambulatory BP or home reading
What are the stages of hypertension?
stage 1 - 140/90 (clinic) 135/85 (a)
stage 2 - 160/100 (clinic) 150/95 (a)
stage 3 - 180/120 (clinic)
What further tests should be done when a patient has confirmed hypertension to check for organ damage?
- Urine albumin: creatine ratio and dipstick (kidney damage)
- Bloods: HbA1c, renal function and lipids
- Fundus examination (hypertensive retinopathy)
- ECG (cardiac abnormalities)
What medications are used for hypertension?
- ACE inhibitors
- Beta blockers
- Calcium channel blockers
- Thiazide like diuretics
- ARBs
Give an example of an ACE inhibitor?
ramipril
Give an example of a Beta blocker?
Bisoprolol
Give an example of a calcium channel blocker?
Amlodipine
Give an example of a thiazide like diuretic?
Indapamide
Give an example of an ARB?
Candesartan
When are ARBs used instead of ACE inhibitors?
- if ACE inhibitors not tolerated due to dry cough for example
- black African or African-Caribbean patients
What lifestyle advice should be offered to patients diagnosed with hypertension?
- healthy diet
- stop smoking
- reduce alcohol
- reduce caffeine
- reduce salt intake
- take regular exercise
Who should be offered treatment for their hypertension?
- Anyone with stage 2
- Stage 2 and under 80 and Qrisk above 10% or who has diabetes, renal disease, CV disease or organ damage
What are the first, second, third and fourth line treatments for non-black patients under 55?
1) ACE inhibitors
2) ACE inhibitors + CCB or ACE + Diuretics or CCB + Diuretics
3) ACE + CCB + Diuretics
4) ACE + CCB + Diuretics + either potassium sparing diuretic, alpha blocker or beta blocker
What are the first, second, third and fourth line treatments for black patients or anyone over 55?
1) CCB
2) CCB + ARB
3) ARB + CCB + Diuretic
4) ARB + CCB + Diuretic + either potassium sparing diuretic, alpha blocker or beta blocker
How should the additional medication given in fourth line treatment be chosen?
Serum potassium below 4.5 mmol/l give potassium sparing diuretic if above then alpha or beta blocker
Give an example of an alpha blocker?
Doxazosin
Give an example of a beta blocker?
Atenolol
What is the action of spironolactone and what does it cause?
Blocks action of aldosterone in the kidneys resulting in sodium excretion and potassium reabsorption so “potassium sparing”
What drugs can cause a potassium imbalance?
Hyperkalaemia = Spironolactone and ACE inhibitors
Hypokalaemia = thiazide diuretics
(important to check U&Es for all)
What are the treatment targets for hypertension?
<80 years = below 140/90
>80 years = below 150/90
