Hypertension Flashcards
What is the definition of hypertension? (3 points)
- Persistently elevated arterial blood pressure >140/90mmHg
- The BP level that increases the vascular risk in patients sufficient to require intervention
- The threshold at which the benefits of action exceed those of inaction
What is hypertension a risk factor for?
- Development of coronary artery disease
- cerebrovascular disease
- Peripheral vascular disease
- Heart failure
- End stage renal disease
What are the non modifiable risk factors associated with hypertension?
- age
- Gender
- Race
- Genetic factors
What are the modifiable risk factors of hypertension?
- Exercise
- Diet
- Obesity
- alcohol in excess
- Stress
What are the endocrine causes of hypertension?
- Hyperaldosteronism
- Phaeochromocytoma
- Thyroid disorders
- Cushing’s syndrome
What are the vascular causes of hypertension?
coarctation of the aorta
What are the renal causes of hypertension?
- Renal artery stenosis
* Renal parenchymal disease
What drugs can cause hypertension?
- NSAIDs
- Herbal remedies
- Cocaine
- Exogenous steroid use
What are the physical examination components of a systemic hypertension assessment?
- BP readings of both arms, consider ABPM
- Examination of the heart and lungs
- Ausculation for carotid/abdominal/femoral bruit
- Examination of the thyroid gland
- Examination of the abdomen
- Palpation of the lower extremities for oedema and pulses
- Optic fundi examination
- Neurological exam and cognitive status assessment
What investigations should be carried out in the assessment of hypertension?
- Routine metabolic panel and lipids
- Renal function (eGFR and Creatinine)
- FBC
- Urinalysis
- ECG
What investigations should be carried out in the assessment of hypertension?
- Routine metabolic panel and lipids
- Renal function (eGFR and Creatinine)
- FBC
- Urinalysis
- ECG
If you are suspecting a secondary hypertension or if the BP has been hard to control, what extra tests should be carried out?
- Echocardiogram and doppler
- Sleep study (looking for signs of obstructive sleep apnoea)
- Pheochromocytoma screen
- TFTs
- Plasma renin/aldosterone
- Renal artery imaging
What are the lifestyle modifications for the management of systemic hypertension?
- Education
- Sodium reduction
- DASH diet
- Weight loss to a BMI of about 25kg/m^2
- Increased physical activity (150 mins a week)
- Limited alcohol consumption
- Smoking cessation
What are the steps of pharmacological management of hypertension?
- Step 1: CCB (>55/black African) or ACEi/ARB (<55)
- Step 2: ACEi or ARB, and CCB (or switch the new drug out for a thiazide like diuretic)
- Step 3: ACEi/ARB, CCB and thiazide like diuretic or an alpha or beta blocker (depending on potassium level)
What is the pathophysiology of hypertension?
At what blood pressure measurement in clinic should you start drug treatment immediately?
Over 180/120mmHg if there is also target organ damage
When should you refer for same day specialist review in HTN?
•180/120mmHg if there is retinal haemorrhage/papilloedema or life threatening symptoms or suspected pheochromocytoma
Name 5 examples of end organ damage
- Blindness
- Heart attack/failure
- Kidney failure
- Arterioslcerosis
- Stroke
What is grade 1 hypertension?
- Systolic 140-159 mmHg
* Diastolic 90-99
What is grade 2 hypertension?
- Systolic 160-179
* Diastolic: 100-109
What is grade 3 hypertension?
- systolic ≥180
* Diastolic ≥110
What is isolated systolic hypertension?
- Systolic ≥ 140
* Diastolic <90
Management of Grade 1 hypertension
- Lifestyle advice
- Immediate drug treatment in high or very high risk patients with CVD, renal disease or HMOD
- Drug treatment in low risk patients after 3-6 months of lifestyle intervention if BP is not controlled
What is the management of grade 2 or 3 hypertension?
- Lifestyle advice
- Immediate drug treatment in all patients
- Aim for control within 3 months
