Hypertension Flashcards
What is systolic, diastolic and pulse pressure?
Systolic (top number) - BP when heart contracts
Diastolic (bottom number) - BP when heart relaxes
Pulse pressure = difference between systolic and diastolic
What is the difference between primary and secondary hypertension, which is most common and what are the causes?
Primary (most common) - no underlying cause, risk assessed with QRISK3
Secondary - Renal disease, drug-induced…..
What drugs can induce hypertension?
- Sympathomimetics
- NSAIDS
- Venlafexine
- Oral contraceptives/HRT containing oestrogen
- Corticosteroids
- immunosuppressants
- Mirabegron
- illicit drugs
- alcohol and excess caffeine
What is the clinical presentation of hypertension?
Often incidental finding - most asymptomatic until hypertension-mediated organ damage occurs
What is malignant hypertension?
Very high BP occurring suddenly without warning (>200/130mmHg), medical emergency
What are some common errors in BP measurement?
- incorrect patient positioning
- restrictive clothing
- caffeine, smoking, exercise, alcohol 15 mins prior
- incorrect cuff size or position
What is postural hypotension?
A drop in blood pressure when standing up or sitting down, >20mmHg is considered significant and may warrant a management change
How do you confirm a diagnosis of hypertension?
- Clinic blood pressure of 140/90mmHg or higher AND
- ABPM daytime average / HBPM of 135/85mmHg or higher
What patient groups have a better response to CCBs for hypertension?
> 55 yrs and black African / Caribbean patients
When are alpha and beta blockers considered for hypertension?
Patient has a blood K level >4.5mmol/L / patient has CV co-morbidity benefiting from BB
What significantly interacts with beta blockers?
rate-limiting CCBs (Verapamil/Dilitiazem)
What medication is reserved for resistant hypertension or for use in pregnancy?
Methyldopa
What two drug classes should not be combined to treat hypertension due to a risk of hyperkalemia?
ACE Inhibitors and Angiotensin 2 receptor blockers (ARBs)
