Hypertension Flashcards
What BP is the NICE guidelines diagnosis BP for HTN?
140/90 – clinic
135/85 – ambulatory / home
What are the risk factors for HTN? (7 things)
- Male
- Age
- FHx
- Smoking / Alcohol
- Obesity
- High Na diet
- Physical inactivity
What are the causes of secondary HTN? (4 things)
- R – Renal disease
- O – Obesity
- P – Pregnancy induced HTN / Pre-eclampsia
- E – Endocrine
ROPE
What Renal disease causes secondary HTN?
Renal artery stenosis
What is the most common Endocrine cause of secondary HTN?
Hyperaldosteronism
How do you check if Hyperaldosteronism is the cause of the secondary HTN?
Renin:aldosterone ratio blood test
How do you confirm the diagnosis of HTN of a patient with clinic BP between 140/90 – 180/120?
24 hour ambulatory BP / home reading
What are the Clinic and Ambulatory/Home readings for Stage 1 HTN?
Clinic = >140/90
Ambulatory/Home = >135/85
What are the Clinic and Ambulatory/Home readings for Stage 2 HTN?
Clinic = >160/100
Ambulatory/Home = >150/95
What is the reading for Stage 3 HTN?
180/120+
What investigations should be done to check for End Organ Damage for newly diagnosed HTN patients? (5 things)
- Fundus examination
- ECG
- Bloods
- Urine dipstick
- Urine albumin:creatinine ratio
What are you checking for in Urine albumin:creatinine ratio for newly diagnosed HTN patients?
Proteinuria
What are you checking for in Urine dipstick for newly diagnosed HTN patients?
Haematuria
What are you checking for in Bloods for newly diagnosed HTN patients? (3 things)
- HbA1c
- Renal function
- Lipids
What are you checking for in Fundus examination for newly diagnosed HTN patients?
Hypertensive retinopathy
What are you checking for in ECG for newly diagnosed HTN patients?
Cardiac abnormalities
What are all the medications used for HTN? (5 things)
- A – ACE inhibitors (e.g. Ramipril 1.25 – 10mg once daily)
- B – Beta blockers (e.g Bisoprolol 5 – 20mg once daily)
- C – Calcium channel blocker (e.g Amlodipine 5 – 10mg once daily)
- D – Thiazide-like Diuretic (e.g Indapamide 2.5mg once daily)
- ARB – Angiotensin II Receptor Blocker (e.g Candesartan 8 – 32mg once daily)
When are ARBs used in HTN?
Instead of ACE inhibitor if patient: nigga or doesn’t tolerate ACE inhibitors
ACE inhibitors and ARBs are NOT used together
What is the initial management of HTN? (3 things)
- Establish diagnosis
- Investigate for Causes + End Organ Damage
- Lifestyle advice
Who is offered MEDICAL management for HTN? (2 things)
- Under 80 yrs w Stage 1 HTN + Q-risk score 10+% / DM / Renal/CVS Disease / End Organ Damage
- All Stage 2 HTN patients
What is the step wise approach to HTN medication? (4 steps)
Step 1: A (less than 55yrs + white) / C (55+ / nigga)
Step 2: A + C (white) / ARB + C (nigga)
Step 3: A + C + D
Step 4:
Serum K less than 4.5 = A + C + D + Spironolactone (K sparing diuretic)
Serum K more than 4.5 = A + B/alpha blocker + C + D
What is a complication of Spironolactone?
Hyperkalaemia
What is a complication of ACE inhibitors?
Hyperkalaemia
What is a complication of Thiazide-like diuretics?
Electrolyte disturbances
What should you monitor when using ACE inhibitors and diuretics on HTN patients?
U&Es regularly
What is the treatment target for a HTN patient who is younger than 80?
Less than 140/90
What is the treatment target for a HTN patient who is older than 80?
Less than 150/90
What are the complications of HTN? (5 things)
- Stroke / brain haemorrhage
- Hypertensive retinopathy
- HF
- Ischaemic heart disease
- Hypertensive nephropathy
