Hypertension Flashcards
What is stage 1 hypertension?
ABPM/HBPM average reading 135/85 to 149/94
What is stage 2 of hypertension?
150/85 to 179/119
What is stage 3 of hypertension?
> 180/20
What is hypertensive urgency?
Hypertensive crisis with no target organ damage
What are the symptoms of hypertensive urgency?
Headache
Shortness of breath
Nosebleed
Severe anxiety
What is the management of hypertensive urgency?
Oral medication and outpatient treatment
What is a hypertensive emergency (a.k.a malignant hypertension)?
Hypertensive crisis with target organ damage
What are the symptoms of a hypertensive emergency?
Chest pain Shortness of breath Back pain Numbness/ weakness Vision change Difficulty speaking
What is the management of hypertensive emergency?
Inpatient treatment with intravenous medication to relax arteries (vasodilators, calcium channel blockers, beta blockers)
What investigations might you carry out to determine if there is target organ damage and to assess cardiovascular risk?
- U&E, GFR
- HbA1C
- Lipid profile
- Urine albumin: creatinine ratio
- ECG
What key organs should you focus on when assessing for end organ damage?
- Eye (hypertensive retinopathy)
- Brain (hypertensive cerebrovascular disease)
- Heart (left ventricular hypertrophy, ischaemic heart disease with or without heart failure)
- Kidneys (hypertensive nephropathy - damaged glomerulus and shrunken kidney)
What are the features of hypertensive retinopathy?
- Flame haemorrhage
- Hard exudates
- Cotton wool spots
- Papilloedema
List 14 causes of secondary hypertension
- Renovascular disease
- Primary renal disease
- Oral contraceptives
- NSAIDs
- Stimulants (e.g. cocaine, methylphenidate)
- Calcineurin inhibitors
- Antidepressants
- Pheochromocytoma
- Primary aldosteronism
- Cushing’s syndrome
- Sleep aponea syndrome
- Coarctation of the aorta
- Hypothyroidism
- Primary hyperparathyroidism
What is the first choice drug for someone with hypertension under the age of 55 and who is not of black African or African-Caribbean family origin?
ACEi or ARB
What is the first choice drug for someone with hypertension aged 55 or over?
CCB
What is the first choice drug for someone who is of black African or African-Caribbean family origin?
CCB
Which are second stage drugs for someone with hypertension under the age of 55 and who is not of black African or African-Caribbean family origin?
ACEi/ ARB
+
CCB or thiazide-like diuretic
What are the second stage drugs for someone with hypertension aged 55 or over?
CCB
+
ACEi/ ARB or thiazide-like diuretic
What are the second stage drugs for someone who is of black African or African-Caribbean family origin?
CCB
+
ACEi/ ARB or thiazide-like diuretic
What are third stage drug combinations in all groups?
ACEi/ ARB
+
CCB
+
Thiazide-like diuretic
What are step 4 drugs in resistant hypertension?
Confirm resistant hypertension and discuss adherence
Consider seeking expert advice or adding a:
Low-dose spironolactone if blood potassium =4.5mmol/l
Alpha-blocker or beta-blocker if blood potassium level >4.5mol/l
A 60 year old lady has been confirmed to have a BP of 156/95 mm Hg for the last three to four months with no evidence of end organ damage. Her BMI was 31. Her GP gave her some advice to reduce weight and salt in her diet. 3 months later, her BP is 150/91 and BMI hasn’t changed.
What should the next step be?
Continue life style measures and Start ACEI
What is the management of a patient unable to control their BP even after 4 agents?
Consider specialist referral to rule out secondary causes
What is the management of a patient with BP 180/110 but with no evidence of end organ damage?
Manage in primary care
