hypertension Flashcards
what is hypertension
- term used to describe high blood pressure
- 140/90 in clinic or 135/85 with ambulatory or home readings.
RISK factors for hyoertension
Modifiable ;
Alcohol
Sedentary lifestyle
DM
sleep apnoea
Smoking
Non mod ;
Age
Fhx
Ethnicity
causes of hypertension
primary hypertension 95% of cases - develops on its own and no secondary cause
what are the secondary causes of hypertension
R – Renal disease. This is the most common cause of secondary hypertension.
O – Obesity
P – Pregnancy induced hypertension / pre-eclampsia
E – Endocrine.
why do most endocrine conditions cause hypertension
Due to hyperaldosteronism
complications of hypertension
Ischaemic heart disease
Cerebrovascular accident (i.e. stroke or haemorrhage)
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure
Monitoring of patients with a diagnosis of HT
NICE recommendation - blood pressure every 5yrs
every year for patients with T2DM
Patients with a clinic blood pressure between 140/90 mmHg and 180/120 mmHg should…?
have a 24hr ambulatory blood pressure or home readings to confirm the diagnosis
why does having blood pressure taken by a doctor or nurse usually have a higher reading
white coat syndrome - defined as more than a 20/10 mmHg difference in blood pressure between clinic and ambulatory or home readings
stages of hypertension
Stage 1 Hypertension C >140/90 A/H>135/85
Stage 2 Hypertension C>160/100 A/H >150/95
Stage 3 Hypertension C>180/120
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 abnormalitie
WHEN TO REFEr
BP >180/20 +
signs of accelerated hypertension
life threatening feautures
suspected phaeochromocytoma
initial management of HT
- establish a diagnosis
- investigate for possible causes and end organ damage
- advise on lifestyle
who is medical management offered to
All patients with stage 2 hypertension
All patients under 80 years old with stage 1 hypertension that also have a Q-risk score of 10% or more, diabetes, renal disease, cardiovascular disease or end organ damag
different guidelines for over 55 and black
step 1 =C
STEP 2= ARB+C
STEP 3= A+C+D
STEP 4= A+C+D+ 4th drug
what 4th drug would you consider for step 4
is K is less than or equal to 4.5 then spironolactone
if more than 4.5 then alpha or beta blocler
side effects of spironolactone
hyperkalaemia
why may a patient be switched from an ace inhibitor to ARB
ACE CAUSES a dry cough due to increased bradykinin
treatment targets
younger than 80 140/90
older than 80 150/90
35yr old female presents with palpitations , headaches, sweating and anxiety
BP 180/100 mg
what is the most likely diagnosis
phaeochromocytoma
What changes can occur in primary hypertension
loss of elastin in arteries due to age
what are some secondary causes of htn
glomerulonephritis
adult pkd
cushings
nsaids
pregnancyy
treatment pathway for over 55 and diabetic
step 1- A
step 2 A+c or A+D
step 3- A+C+D
Step 4- if k+ < = 4.5 add low dose spironolactone
more than 4.5 then add alpha or beta blocker
SE of ccb
flushing
ankle swelling
headache
SE of acei
cough
angiodema
hyperkalaemia
most common cause of secondary htn
renal disease
pkd