hypertension Flashcards
what is stage 1 hypertension?
clinical: >= 140/90
APBM: >= 135/85
what is stage 2 hypertension?
clinical: >= 160/100
APBM: >= 150/95
what is stage 3/severe hypertension?
=> 180 systolic
=> 120 diastolic
what is isolated systolic hypertension?
systolic => 160
what is hypertensive crisis?
=> 200/120 + papilloedema
when should secondary disease be considered as the cause for hypertension?
less than 40 years old
resistant BP
positive findings on U+Es
when should treatment be offered?
for stage 2 and above
when should treatment be offered for stage 1?
<80 years old has diabetes renal disease end organ damage cardiovascular disease 10 years cardiovascular risk >20%
what is the treatment for a patient <55 years or T2DM ?
step 1: ACE inhibitor
step 2 : A + CCB or A + thiazide diuretic
step 3: A + B + C
what it the treatment for a patient =>55 years or Afro-Caribbean?
step 1: CCB
step 2: C + ACE inhibitor or C + thiazide diuretic
step 3: A+ B + C
what is step 4 for hypertension management?
step 4: K <= 4.5 spironolactone
K >4.5 alpha blocker or beta blocker
what treatment should hypertensive patients with T1DM be started on? why?
ACE inhibitor
due to renal protective effect
when can beta blockers be used first line?
in younger patients who:
can’t tolerate ACE
may become pregnant
have sympathetic drive signs - sweating, palpitations
what is a hypertensive emergency?
BP >200/120 with evidence of end organ failure
what causes a hypertensive emergency?
thyroid storm phaeocromocytoma pre-eclampsia head injury drugs
what is the management for hypertensive emergency?
no end organ damage: oral treatment
end organ damage (especially CCF or encephalopathy):
- labetalol if no LV failure
- furosemide + hydralazine if LV failure
what is the aim of management in hypertensive crisis?
not a sudden drop in BP, slowly brought down over 24 hours
can cause stroke or dissection
if BP is >= 180/20, when should they be admitted for specialist treatment?
signs of retinal haemorrhage or papilloedema
life threatening symptoms - new onset confusion, chest pain, signs of heart failure, acute kidney injury
if BP >=180/20 but no signs of concern or life threatening symptoms, what should the next step be?
urgent investigation of end-organ damage
- if found, start treatment immediately
- if not found, repeat clinic blood pressure within 7 days
when does ABPM take measurement?
least 2 measurements per hour during person’s usual waking hours (between 8-10)
use average of 14 values
how do you record BP using home blood pressure monitoring?
- 2 consecutive readings, 1 min apart with patient seated
- twice daily, ideally morning and evening
- at least 4 days, ideally 7
- discard first day measurement and use average of remaining
what is the target BP for patient <80 years?
clinic - 140/90
ABPM - 135/85
what is the target BP for patient >80 years?
clinic - 150/90
ABPM - 145/85
what are ACE inhibitors mechanism of action?
stop angiotensin I conversion to angiotensin II
what are the common side effects of ACE inhibitors?
cough
hyperkalaemia
angioedema
when must ACE inhibitors be avoided?
in pregnant woman
what must be checked in a patient on an ACE inhibitor?
renal function must be checked 2-3 weeks after starting due to risk of worsening renal function in patients with renovascular disease
what is the mechanism of action of CCB?
block voltage gated calcium channels
-relaxing vascular smooth muscle and force of myocardial contraction
what are the common side effects of CCB?
flushing
ankle swelling
headache
what is the mechanism of action of thiazide diuretics?
inhibit sodium absorption at the beginning of the distal convoluted tubule
what are the side effects of thiazide diuretics?
hypokalaemia
hyponatraemia
dehydration
what is the mechanism of action of angiotensin II receptor blockers?
block effect of angiotensin II at the AT1 receptor
what are the side effects of angiotensin II receptor blockers?
hyperkalaemia
when are angiotensin II receptor blockers most commonly used?
when a patient can’t tolerate an ACE inhibitor, most commonly due to cough
