Hypertension Flashcards
Define Hypertension
Sustained SBP > 140 mm Hg +/or DBP > 90 mm Hg measured on 3 separate occasions
Define Malignant Hypertension
Severe increase in BP >, 180/120 mmHg (often > 220/120 mmHg) with signs of retinal haemorrhage +/or papilloedema
Describe the aetiology of Hypertension
Primary/ Essential= 90% Idiopathic
Secondary= 10% has underlying cause
List 5 systems/ states with their respective causes of secondary hypertension
Renal: glomerulonephritis, RAS, PKD, chronic pyelonephritis, CKD
Endocrine: DM, Cushings, Conns, phaeochromocytoma, hyperthyroidism, CAH, acromegaly
CVS: aortic coarctation, high intravascular volume
Drugs: sympathomimetics, corticosteroids, OCP
Pregnancy: pre eclampsia
Describe the epidemiology of hypertension
> 25% of UK adults
How does hypertension present?
Often asymptomatic
Symptoms of complications
Symptoms of the cause
Give 6 features of malignant hypertension presentation
Scotomas (visual field loss) Blurred vision Severe headaches Seizures N + V Acute heart failure
How is hypertension diagnosed?
Record BP on 3 separate occasions
Record lowest reading
If 140/90 - 180/120, offer ABPM.
Which 3 signs may present in a hypertensive patient, suggesting the cause?
Radiofemoral delay = coarctation of the aorta
Renal artery bruit = renal artery stenosis
Fundoscopy = hypertensive retinopathy
Describe the Keith-Wagner Classification of Hypertensive Retinopathy
i. Silver wiring
ii. As above + arteriovenous nipping
iii. As above + flame haemorrhages + cotton wool exudates
iv. As above + papilloedema
List the appropriate investigations for hypertension
Bloods (FBC, U+E’s, Lipids, Glucose)
Urine dipstick (blood + protein for renal causes)
ABPM (exclude white coat HTN)
ECG (LV hypertrophy)
Describe 4 strategies in conservative management of hypertension
Stop smoking
Lose weight
Reduce alcohol intake
Reduce dietary sodium
What is the mnemonic for medical treatments for hypertension? Give examples
CAT AB CCB: Amlodipine ACEi: Ramipril Thiazide diuretic: Bendroflumethiazide A/B blockers: Doxazosin/ Atenolol
What is the first line pharmacological treatment of hypertension?
If <55, Diabetic, HF or LV dysfunction: ACEi or ARB
If >55/ Black: CCB
What are the target BP’s aimed for with treatment?
<140/90 non diabetic + < 80
<130/80 diabetic
<125/75 diabetic with proteinuria
Name 2 drugs used to treat malignant hypertension
Atenolol
Nifedipine
What is used for Malignant Hypertension treatment with encephalopathy?
IV BB e.g. Labetalol
or
IV Na nitroprusside
Why must you avoid rapid lowering of blood pressure when treating acute malignant hypertension?
Can cause cerebral infarction
Autoregulatory mechanisms in brain for regulating blood flow will cause vasoconstriction of vessels in brain when BP is very high
Lowering BP too rapidly would mean autoregulatory mechanisms do not adapt to the drop in BP + so the vessels remain constricted
Rapid drop in BP with constricted vessels will cause an infarction
List 10 possible complications of hypertension
Heart failure CAD Cerebrovascular accidents PVD Lacunar brain haemorrhages Emboli Renal failure Hypertensive retinopathy Hypertensive encephalopathy Malignant HTN
Describe the prognosis of a patient with hypertension
Good if well controlled.
Uncontrolled, increases risk of stroke 3x, MI 6x + renal + heart failure.
What is papilloedema?
Optic disc swelling due to raised ICP
Sharp optic disc edge is NOT visible