Hypertension Flashcards
If new BP > 180/20 + no worrying signs …
Urgent investigations for end organ damage: ECG, urine dip, blood tests
If new BP >180/20 and worrying signs.. (new-onset confusion, chest pain, signs of heart failure, or acute kidney injury)
Urgent same day specialist assessment
If clinic reading >140/90…
Offer ABPM or HBPM
If ABPM / HBPM > 135/85…
Stage 1 hypertension
treat stage 1 hypertension IF … AND …
> 80yo AND
-end organ damage
-renal disease
-diabetes
-10yr QRISK2 >10%
If ABPM /HBPM >150/90…
Stage 2 hypertension: treat all patients regardless of age
Hypertension treatment step 1
If less than 55 and non black: ACE
If over 55 or black: calcium channel inhibitor
Hypertension treatment step 2
If non black use: ACE + Calcium channel inhibitor
If black: Calcium channel inhibitor + ARB
Hypertension treatment step 3 and 4
Step 3: A + C + Thiazide like diuretic
Step 4: A + C + D + spironolocation (if Na >4.5) OR Indiapamide (<4.5)
Hypertension treatment step 3 and 4
Step 3: A + C + Thiazide like diuretic
Step 4: A + C + D + spironolocation (if Na >4.5) OR Indiapamide (<4.5)
What must be checked before initiating ACE inhibitors and after increasing dose
U&E
when is indapamide contraindicated in hypertension for 4th line treatment, give instead
in hyponatreamia
what hypertension medication can cause gout flare up by increasing serum uric acid
Bendroflumethiazide
which hypertension drug can cause increase hba1c in diabetes
Bendroflumethiazide
by decreasing insulin secretion and sensitivity
if albumin:creatinine ratio in CKD >30, what hypertension medication should be used in ALL patients?
ACE inhibitor
management of patient <40 stage 1 hypertension and no end organ damage
refer to secondary care to exclude secondary causes of hypertension
maximum dose of ramipril daily
10mg
bp target in CKD with acr >70
<130/80
1st line treatment hypertension type 2 diabetes
ACE or ARB
target bp clinic vs ABMP
age <80
clinic: 140/90
ABMP: 135/85
target bp clinic vs AMBP
>80
clinic: 150/90
ABMP: 145/85
what increase in creatinine is acceptable following the introduction of an ACE inhibitor in CKD
30%
what increase in GFR is acceptable following the introduction of an ACE inhibitor in CKD
25%
referal bp in pregnancy
140/90
what happens to bp in pregnancy
falls in first half and returns to normal in second half
how to treat postural hypertension
based on standing blood pressure
what anti-hypertensive is contraindicated in patients with renovascular disease
Amlodipine
target blood pressure type 2 diabetic
<140/90
