Hypertension Flashcards
What is the value for hypertension?
140/90 in clinic
135/85 home reading
What are the causes of hypertension?
Primary- essential is 95% of cases
Secondary:
R- renal disease
O-obesity
P- pregnancy induced hypertension/ pre-eclampsia
E-endocrine e.g hyperaldosteronism
What are the complications of hypertension?
Ischaemic heart disease
Cerebrovascular accident (i.e. stroke or haemorrhage)
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure
How do we diagnose hypertension?
- readings : clinic + home
- stage 1 >140/90 or > 135/85
- stage 2 >160/100 or >150/95
- stage 3 >180/120
What does NICE recommend all patients with a new diagnosis should have
Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess for kidney damage
Bloods for HbA1c, renal function and lipids
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities
What medications do we give for hypertension?
A – ACE inhibitor (e.g. ramipril 1.25mg up to 10mg once daily)
B – Beta blocker (e.g. bisoprolol 5mg up to 20mg once daily)
C – Calcium channel blocker (e.g. amlodipine 5mg up to 10mg once daily)
D – Thiazide-like diuretic (e.g. indapamide 2.5mg once daily)
ARB – Angiotensin II receptor blocker (e.g. candesartan 8mg to up 32mg once daily)
What is the medical management of hypertension?
Step 1: Aged less than 55 and non-black use A. Aged over 55 or black of African or African-Caribbean descent use C.
Step 2: A + C. Alternatively A + D or C + D. If black then use an ARB instead of A.
Step 3: A + C + D
Step 4: A + C + D + additional (see below)
For step 4, if the serum potassium is less than or equal to 4.5 mmol/l consider a potassium sparing diuretic such as spironolactone. If the serum potassium is more than 4.5 mmol/l consider an alpha blocker (e.g. doxazosin) or a beta blocker (e.g. atenolol).
What are the treatment targets?
Age : < 80 years or > 80 years
Systolic target : <140 < 150
Diastolic < 90 <90
