hypertension Flashcards
what is essential hypertension?
HTN with known cause
what are the diagnostic levels for the different stages of hypertension?
stage 1: clinic ≥140/90 or ABPM ≥135/85
stage 2: clinic ≥160/100 or ABPM ≥150/95
stage 3: clinic ≥180/120
what is malignant hypertension and what do you do if you see it?
≥180/120 with signs of end stage organ damage
nice guidance =send them straightt o hospital
what are the risk factors for hypertension?
increasing age
ethnicity
FH
high salt, sat fat, and trans fat intake
overweight/obese
alcohol misuse
smoking
amphetamines/cocaine
sedentary
what are the 2 type of secondary hypertension?
renal
endocrine
what are the 2 types of renal causes of hypertension?
primary renal disease
renovascular disease
what are the causes of renovascular disease in which groups?
fibromuscular dysplasia -if younger usually
atherosclerosis -if older usually
what is fibromuscular dysplasia (FMD) ?
disease of blood vessels that causes abnormal growth within the wall of the artery -medium sized arteries narrow and can get longer
what are the most common sites of fibromuscular dysplasia?
renal and carotid arteries
what are the symptoms of FMD in the renal arteries?
reduced renal function
high BP
what are the symptoms of FMD in the brain?
headaches
tinnitus
dizziness
what are the RFs for FMD?
female, in 50s, smokers
what are the endocrine causes of hypertension?
conn’s syndrome (excess aldosterone)
cushing’s syndrome (excess cortisol)
phaechromocytoma (excess catecholamines)
what do you do if in clinic someone’s BP is between 140/90 and 180/120?
give them ABPM of HBPM if they can’t do ABPM to confirm diagnosis
check for end organ damage
what do you do if in clinic someone’s BP is over 180/120?
investigate for end organ damage
if none -repeat BP measurement in 7 days
if yes -send to hospital
how do you test for end stage organ damage?
kidneys: urine dip -check for haematuria, urine ACR, plasma U+E
eyes -fundoscopy
heart -ECG
diabetes -hba1c
what ECG changes could you see in someone with severe hypertension?
LVH
what are you looking for in fundoscopy of someone with severe hyptertension?
hypertensive retinopathy -retinal haemorrhage, papilloedema
what are the criteria to refer someone with hypertension for same day specialist assessment?
> 180/120 and: signs of retinal haemorrhage, papilloedema, new onset confusion, chest pain, signs of HF, AKI
suspected phaeochromocytoma
what are some signs of suspected phaeochromocytoma?
labile BP or postural hypotension, headaches, palpitations, pallor, abdo pain, diaphoresis
what is diaphoresis?
excess sweating
what does labile mean?
easily changed
how do you investigate for suspected renal hypertension?
renal USS +doppler
in which situations would you investigate for ?renal hypertension?
resistant HTN
isolated htn in young woman
reduced egfr
proteinuria/haematuria
acute pulmonary oedema
patient has atherosclerosis
renal artery bruits
how do you investigate for ?aldosterone excess?
plasma aldosterone: renin ratio
in which situations would you investigate for ?aldosterone excess?
resistant HTN
hypokalaemia
which blood results suggest aldosterone excess?
low k+
normal na+
high bicarb
what do you do if there’s ?aldosterone excess based on clinic picture and bloods?
CT with/without selective venous sampling
what is the non pharmacological management for hypertension?
diet modification
weight loss
discourage excessive caffeine consumption
smoking cessation
reduced alcohol
calculate QRISK3 and act accordingly
what is the drug treatment pathway for chronic hypertension?
https://www.notion.so/hypertension-d9a07e5cf2884ac3a08350e65c7a036b?pvs=4#5ce2ca444bfe4945bba9b812f49b5a5e
what’s an important monitoring point about ACEis?
after initiation and every dose change you have to check kidney function in the next 2 weeks.
what are 2 examples if ACEis?
ramipril, lisinopril
what are 2 examples of ARBs?
losartan, candesartan
what is an example of a CCB?
amlodipine
what is the most common complaint for CCBs and a solution to this?
swollen ankles
can try licandopine which doesn’t tend to do it as much
what is an example of a thiazide like diuretic?
indapamide
how do thiazide like diuretics work?
inhibit na/cl pump in distal nephron -pee out more sodium -pee out more water -less circulating blood volume
what drug should you give for hypertension in people with evidence of heart failure?
thiazide like diuretic
what is an example of a potassium sparing diuretic?
spironolactone
how does spironolactone work?
aldosterone receptor antagonist -competitively inhibits aldosterone via its receptors in the DCT
what is the most common contraindication of beta blockers?
any history of obstructive airway disease or bronchospasm, eg asthma, COPD
what are the recommended alpha blockers to use in hypertension?
doxazosin and terazosin
what is the most common contraindication of alpha blockers?
postural hypotension
what are some examples of SGLT2 inhibitors?
empagliflozin, canagliflozin
what are the BP targets for blood pressure on medications?
adults <80: <140/90
adults 80+: <150/90
what is the management of renal hypertension?
- primary renal disease: treat underlying cause, manage as any other htn
- renovascular disease: stenting of renal artery stenosis if possible, avoid RAAS blocking agents
what is the management of mineralocorticoid excess?
- surgery if caused by single adenoma to remove it
- aldosterone receptor blockers
