Hypertension Flashcards
What is hypertension?
Blood pressure above which the benefits of treatment outweigh the risks in terms of morbidity and mortality
What is classed as a hypertensive blood pressure?
140/90mmHg
What are the two types of hypertension?
Primary/essential
Secondary
How many stages of hypertension are there?
Three
Whart blood pressure readings are classed as stage 1 hypertension?
Clinic BP- 140/90mmHg
ABPM-135/85mmHg
Whart blood pressure readings are classed as stage 2 hypertension?
Clinic BP- 160/100mmHg
ABPM-150/95mmHg
Whart blood pressure readings are classed as stage 3 hypertension?
180/110mmHg
What are the secondary causes of Hypertension?
R-Renal disease
O-Obesity
P-Pregnancy
E-Endocrine
If the blood pressure is very high or not responding to treatment in someone with renal disease, what should you consider?
Renal artery stenosis
What is the most common endocrine cause of high blood pressure?
Hyperaldosteronism
What are possible complications of hypertension?
- Ischaemic heart disease
- Cerebrovascular accident (i.e. stroke or haemorrhage)
- Hypertensive retinopathy
- Hypertensive nephropathy
- Heart failure
How should blood pressure be measured when considering a diagnosis of hypertension?
Should be measured in both arms
When should you repeat blood pressure monitoring?
- The difference in readings between arms is more than 20 mmHg
- if the first reading is > 140/90 mmHg.
What is a possible pathological cause of blood pressure readings being different in two arms?
supravalvular aortic stenosis.
What are the main drug causes of hypertension?
NSAID’s
Steroids
What are the main cardiovascular causes of hypertension?
Sleep apnoea
Coarctation of the aorta
What are lifestyle changes for the management of hypertension?
healthy diet,
Stopping smoking
Reducing alcohol
Caffeine and salt intake
Taking regular exercise.
What classification of hypertension are given mendication?
Stage 2 hyoertension
Which patients with stage1 hypertension are given medication?
Q-risk score of 10% or more, diabetes, renal disease, cardiovascular disease or end organ damage.
Which medications are used in the management of hypertension?
A – ACE inhibitor
B – Beta blocker
C – Calcium channel blocker
D – Thiazide-like diuretic
ARB – Angiotensin II receptor blocker
What is step 1 in the management of hypertension?
Aged less than 55 and non-black use A.
Aged over 55 or black of African or African-Caribbean descent use C.
What is step 2 in the management of hypertension?
A + C.
Alternatively A + D or C + D.
If black then use an ARB instead of A.
What is step 3 in the management of hypertension?
A + C + D
What is step 4 in the management of hypertension?
A + C + D + additional
What additional drugs can be given in step 4 of the management of hypertension?
Potassium sparing diuretic (spironolactone
Alpha blocker (doxazosin) or a beta blocker (atenolol).)
When would a potassium sparing diuretic be used in the fourth step of the management of hypertension?
If the serum potassium is less than or equal to 4.5 mmol/l
When would a potassium sparing diuretic not be used in the fourth step of the management of hypertension?
If the serum potassium is more than 4.5 mmol/l
When would ARB’s be used rather than ACEi in the management of hypertension?
Patient is black of African or African-Caribbean descent
What investigations might you consider doing for end organ damage?
- Urine albumin: creatinine ratio for proteinuria and dipstick for microscopic haematuria- kidney damage
- Bloods for HbA1c, renal function and lipids
- Fundus- hypertensive retinopathy
- ECG -cardiac abnormalities
