Hypertension Flashcards
What is normal BP
Systolic <120mmHg
Diastolic <80 mmHg
What is the BP is severe hypertension
Clinic:
Systolic 180 mmHg or higher
Or
Diastolic 110 mmHg or higher
What BP is stage 1 hypertension
Clinic:
Systolic 140 mmHg or higher
Diastolic 90 mmHg or higher
ABPM or HBPM daytime average: 135/85 mmHg or higher
What is stage 2 hypertension
Clinic:
Systolic 160 mmHg or higher
Diastolic 100 mmHg or higher
ABPM or HBPM daytime average: 150/95 mmHg or higher
What does high blood pressure do to the blood vessel walls?
Causes wear and tear to the endothelial wall, can develop tears (damage) -> MI, aneurysm, stroke
What is primary hypertension
Hypertension with no clear cause, pressure in arteries slowly increase
Risk factors for hypertension
- Old age (>65)
- Obesity
- Salt-heavy diets
- Inactive lifestyles
- Smoking
- Lots of alcohol and caffeine consumption
can be improved with lifestyle changes
What is secondary hypertension
Caused by an underlying issue e.g anything lowering renal blood flow (blood flow to kidneys)
Examples of what can limit blood flow to kidneys:
->atherosclerosis, vasculitis, aortic dissection
->fibromuscular dysplasia (thickening of arteries, mostly occurs in young women)
Also be caused by a tumour which produces excess aldosterone which also causes water retention (like renin)
How does low renal blood flow cause hypertension
Kidney secretes hormones REnin when there is not enough blood flow to it -> helps the kidneys REtain more water
That water contributes to more blood in arteries making them more full = higher pressure (hypertension)
What is a hypertensive crisis
Systolic pressure > 180mmHg
And/or
Diastolic pressure > 120mmHg
What are the two types of hypertensive crisis
- Urgency:
No damage to end organs e.g. the brain, kidneys, heat, lungs
Emergency: - Damage to end organs
What are the symptoms of primary hypertension
Usually none (silent killer)
What are the symptoms of secondary hypertension
Variety of symptoms associated with underlying cause
What are the symptoms of emergency hypertension
Confusion
Drowsiness
Chest pain
Breathlessness
What are the first line treatment of hypertension
Lifestyle changes:
- diet
- exercise
- stress reduction
Antihypertensive medication
What is hypertension a big risk factor for?
Heart disease and stroke
Home blood pressure monitoring (HBPM)
- 2 consecutive seated measurements, 1 min apart
- BP recorded twice a day for at least 4 days, preferably 7
- measurements on 1st day discarded, average value for all remaining is used
Ambulatory Blood Pressure Monitoring (ABPM)
At least 2 measurements per hour during the persons usual waking hours (usually 14 times per day)
What is the white coat effect?
- Patients exhibit hypertension only during a clinical visit
- a discrepancy of more than 20/10mmHg between clinic and average ABMP or average HBPM
How to asses cardiovascular risk and target organ damage e.g tests
- Test urine for presence of protein
- Take blood to measure: glucose, e;e truly tes, creatina, estimated glomerular filtration rate and cholesterol
- Examine fundi for hypertensive retinopathy, Funduscopic examination
- Arrange a 12-lead ECG
Examples of established vascular disease which gives a >20% CV risk over ten years
Ischaemic heart disease
Verbo-vascular disease
Peripheral vascular disease
Diabetes
What to do/ask on assessment
- Medical history
- Familial hypercholesterolemia (FH) - genetic disorder causing premature coronary vascular disease
- Smoking
- CV examination (pulses, bruits - ‘thrill’ or palpable vibratory sensation over vessel - turbulence)
- Repeated BPs
-or ABPM or home monitoring - Examine fundi? Carry out a funduscopy, usefulness is questioned
What are the classifications of hypertensive retinopathy
Grade I - slight/modest narrowing of retinal arterioles
Grade II - modest-severe narrowing of retinal arterioles
Grade II - bilateral soft exudates (fluid that leaks out of blood vessels into nearby tissues) or flame shaped haemorrhages
Grade IV - bilateral optic nerve oedema
After drug treatment, what is the target blood pressure in people aged under 80 in the clinic?
140/90 mmHg
