Hypertension Flashcards
Diagnosis of hypertension
BP of 140/90 in clinic or 135/85 with ambulatory or home readings
What is primary hypertension/essential hypertension
Hypertension has developed on its own and does not have a secondary cause
Secondary causes of hypertension(ROPE)
Renal disease(most common cause, consider renal artery stenosis if non responsive)
Obesity
Pregnancy induced hypertension/pre-eclampsia
Endocrine(Conns syndrome)
Test for conns syndrome/hyperaldosteronism
Renin:aldosterone ratio blood test
Complications of hypertension
Ischaemic heart disease Cerebrovascular accident(stroke or haemorrhage) Hypertensive retinopathy Hypertensive nephropathy Heart failure
What is the white coat effect
Higher BP reading when taken by a doctor or nurse
Defined as more than 20/10 mmHg difference in blood pressure between clinic and ambulatory or home readings
IX for all patients with a new diagnosis of hypertension
Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess for kidney damage
Bloods for HbA1c, renal function and lipids
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities
Meds used in hypertension
A – ACE inhibitor (e.g. ramipril 1.25mg up to 10mg once daily)
B – Beta blocker (e.g. bisoprolol 5mg up to 20mg once daily)
C – Calcium channel blocker (e.g. amlodipine 5mg up to 10mg once daily)
D – Thiazide-like diuretic (e.g. indapamide 2.5mg once daily)
ARB – Angiotensin II receptor blocker (e.g. candesartan 8mg to up 32mg once daily)
When are ARBs used in place of an ACE inhibitors
if the person does not tolerate ACE inhibitors (commonly due to a dry cough) or the patient is black of African or African-Caribbean descent. ACE inhibitors and ARBs are not used together.
Alternative if thiazide diuretics are causing hypokalaemia
Potassium sparing diuretics such as spironolactone which work by blocking action of aldosterone in the kidneys
BP target for an individual over 80
Systolic < 150
Diastolic < 90
BP target for an individual under 80
Systolic < 140
Diastolic < 90
ACE inhibitors contraindications and cautions
Angioedema
May lower blood glucose and increase risk of hyperkalaemia in diabetics
ACE inhibitors side effects
Angioedema Arrhythmias Chest pain Cough Diarrhoea
Amlodipine contraindications
Cardiogenic shock
Significant aortic stenosis
Unstable angina
