Hypertension Flashcards
Name conditions in which Hypertension is a major risk factor for
myocardial infarction (MI)
stroke
chronic kidney disease (CKD)
Definition of hypertension
Hypertension refers to a persistent elevation of arterial blood pressure, in adults it is BP >140/90 mmHg
Hypertension is classified based on the degree of hypertension. How many stages are there?
3 stages
Define stage 1 hypertension
BP ≥ 140/90
OR
Ambulatory Blood Pressure Monitoring (ABPM) ≥ 135/85
What is Ambulatory Blood Pressure Monitoring (ABPM)
It is a 24 hour reading of the blood pressure
Gives a more accurate reading of their BP
Define stage 2 hypertension
BP ≥ 160/100
OR
Ambulatory Blood Pressure Monitoring (ABPM) ≥ 135/85
Define stage 3 hypertension
BP ≥ 180/120
OR
Ambulatory Blood Pressure Monitoring (ABPM) ≥ 135/85
At what stage should we start treating hypertension
Everyone stage 2 and 3
Stage 1
Define primary hypertension
Also known as essential
Primary hypertension is when there is no identifiable underlying cause for the hypertension
The majority of hypertension cases are?
a) primary
b) secondary
A) primary - accounts 95% of hypertension cases
Define secondary hypertension
Secondary hypertension is when there is an identifiable cause for the hypertension
accounts for 5% of cases however thought to account for more
Name some of the secondary causes for hypertension
Mnemonic ROPED:
R – Renal disease (most common).
- Renovascular disease (e.g. atheromatous, fibromuscular dysplasia)
- Intrinsic renal disease (e.g. CKD, AKI, glomerulonephritis)
O – Obesity
P – Pregnancy induced hypertension / pre-eclampsia
E – Endocrine:
- Primary aldosteronism (increasingly recognised as a major cause. Conns syndrome)
- Phaeochromocytoma
- Cushing’s syndrome
- Acromegaly
D – Drugs:
- Glucocorticoids
- Oral contraceptives
- SSRIs
- NSAIDs
- EPO
Define Pheochromocytoma
A type of neuroendocrine tumour which is derived from chromaffin cells. These cells are found in the medulla of the adrenal glands and in ganglia and are responsible for producing adrenaline and noradrenaline
What are the typical features of hypertension
Typically asymptomatic.
Any signs and symptoms may reflect underlying end-organ damage or a potential secondary cause.
Symptoms
Palpitations
Angina
Headaches
Blurred vision
New neurology (e.g. limb weakness, paraesthesia)
Signs
New neurology (e.g. limb weakness, paraesthesia)
Retinopathy
Cardiomegaly
Arrhythmias
Proteinuria
Define Conn’s syndrome
Primary aldosteronism (also called Conn’s syndrome) is a rare condition caused by overproduction of aldosterone that controls sodium and potassium in the blood.
Should be considered in patients with hypertension and hypokalaemia and hypernatraemia
Define white coat syndrome
This is the phenomenon in which a patients blood pressure will have a higher reading when they have their blood pressure checked in the clinic
It is defined as more than a 20/10 mmHg difference in blood pressure between clinic and ambulatory or home readings.
How is hypertensive diagnosed
Patients with a clinic blood pressure between 140/90 mmHg and 180/120 mmHg should have 24 hour ambulatory BP measurements (ABPM) to confirm the diagnosis. Those with Stage 3 hypertension (BP ≥ 180/120) immediate treatment is initiated
Blood pressure should be measured in both arms, and if the difference is more than 15 mmHg the reading from the arm with the higher pressure should be used
How often should blood pressure be checked as a screen for hypertension?
Blood pressure should be taken every 5 years to screen for hypertension.
It should be measured more often in patients that are on the borderline for diagnosis (140/90) and every year in patients with type 2 diabetes.
What is the initial management of hypertension
Establish a diagnosis.
Investigate for possible causes and end organ damage.
Advise on lifestyle to remove modifiable risk factors. This includes recommending a healthy diet, stopping smoking, reducing alcohol, caffeine and salt intake and taking regular exercise. Consider the need for anti-platelets or a statin.
If a caucasian patient is 40 with a diagnosis of type 2 diabetes what would be the medical therapy of choice as the first line for his newly diagnosed hypertension
ACE inhibitor e.g. rampiril
Angiotensin receptor blockers are used in place of an ACE inhibitor if the person does not tolerate ACE inhibitors (commonly due to a dry cough)
What is the most common adverse effect from ACE inhibitor?
Dry cough
For patients under the age of 55 with no underlying type 2 diabetes what is the first line therapy for hypertension
ACE inhibitor e.g. rampiril
or
Angiotensin receptor blocker e.g. candesartan if ACE inhibitor is not tolerated
For patients under the age of 55 with no underlying type 2 diabetes what is the second line therapy for hypertension
ACE inhibitor (or Angiotension blocker receptor)
AND
Calcium channel blocker OR Thiazide-like diuretic
Amlodipine is an example of what kind of drug
Calcium channel blocker
Indapamide is an example of what kind of drug
Thiazide-like diuretic
What is the third line therapy for the management of hypertension
ACE inhibitor (or Angiotension blocker receptor)
AND
Calcium channel blocker
AND
Thiazide-like diuretic
What is the first line therapy for hypertension any age patient (not from Black or Caribbean origins) that has a diagnosis of type 2 diabetes
ACE inhibitor e.g. rampiril
Angiotensin receptor blockers are used in place of an ACE inhibitor if the person does not tolerate ACE inhibitors (commonly due to a dry cough)
Fill in the blanks
Name the three strategies to managing hypertension
- Lifestyle modification
- Medication with antihypertensive drugs
- Device based therapies (emerging)
What is the recommended management for stage 1 hypertension
Lifestyle interventions alone for the initial 3-6 months after which drug treatment can be started if not controlled.
When should medications be started immediately in stage 1 hypertension?
Medications should be started immediately if they are at high risk of cardiovascular disease, renal disease or organ damage
What is the recommended management for stage 2 and 3 hypertension
Lifestyle interventions + Medications
Aim for control within 3 months
Name some of the lifestyle interventions for hypertension?
- Education
- Sodium reduction (<1.5 g/day)
- Dietary Approaches to Stop Hypertension (DASH) diet, which includes 8-10 servings of fruit and vegetables daily, whole grains, low sodium and low-fat proteins
- Weight loss to a BMI of about 25 kg/m² is recommended with further target of waist circumference <102 cm for men and <88 cm for women
- Increased physical activity at least 30 minutes of moderate-intensity dynamic aerobic exercise 5 days per week is recommended
- Limited alcohol consumption (not exceeding 14 units per week)
- Smoking cessation – improves general and in particular vascular health
