Hypertension Flashcards
Risk factors for hypertension
Age, Race, Family history, Obesity, Sedentary lifestyle, Smoking,
Alcohol use, High salt diet, Pregnancy, Certain kidney diseases
Sequelae of hypertension
Coronary heart disease, Stroke
True/False: Hypertension prevalence has increased by about 20% in South Africa between 2000-2010
True
The relationship between hypertension and mortality in South Africa
Hypertension contributes to 5 of the top 10 causes of death in SA, and all are increasing
Effect of hypertension on stroke risk
Increases risk of stroke, especially haemorrhagic stroke; for every 10 mmHg the BP rises, another 10kg may as well have been gained
The risk of which conditions decreases if blood pressure decreases?
Stroke, myocardial infarction, heart failure
Considerations for a patient before taking a blood pressure
Let patient rest for 5 min before taking it .
Sit in a chair with both feet together, flat on the ground, with your back straight.
Place your arm at the level of your heart or chest.
Sit still and do not talk while the blood pressure is being measured.
(Measure in morning after waking up and in evenings before going to sleep)
Advantages of automated office BP
Approximates ABPM
Decreases white coat effect
More predictive of end organ damage
Types of hypertension effects
white coat = office blood pressure high, ambulatory blood pressure normal
masked = normal in office, but elevated in ambulatory reading
Criteria for resistant hypertension
Adherent on full doses of three first line agents (including a diuretic) but BP >140/90mmHg without organ damage – only then is a 4th treatment added
Elaborate on the effects of target organ damage caused by hypertension
Kidney (Proteinuria, nephrosclerosis –> chronic renal failure –> end-stage renal disease)
Heart (left ventricular hypertrophy –> coronary artery disease/systolic or diastolic dysfunction/atrial fibrillation or ventricular arrythmias)
Brain (Retinopathy, Binswanger lesions –> dementia, TIA –> stroke)
All of the above can lead to death following the final pathway steps
Which investigations should be done following a diagnosis of Hypertension?
Urine dipstix (1+ protein in hypertensive nephrosclerosis, 2+ or higher proteinuria and/or haematuria suggests kidney disease)
ECG (identify LVH)
Creatinine (identify TOD)
Echocardiogram (identify LVH)
K+/uric acid
Fasting glucose
Fasting lipogram
Urine albumin/creatinine ratio
Factors included in the Framingham risk assessment
Age
Sex
Smoker
Total Cholesterol
DL-C
SBP
HPT Rx
How can you monitor adherence?
Measure amlodipine levels in blood (may also show resistant hypertension)
Causes of secondary hypertension + their screening tests
Kidney disease (dipsticks, renal ultrasound)
Renal artery stenosis (renal ultrasound, captopril renogram, CT angiography)
Phaeochromocytoma (24h metanephrines)
Primary aldosteronism (Low K+, aldosterone:renin ratio)
Partial Liddle’s (R563Q mutation)
Sleep apnoea (refer)
Thyroid disease (TSH)
Parathyroid disease (Ca2+, PTH)
Cushing’s syndrome (24h urine cortisol)
Aortic coarctation (chest radiograph)
List reasons to refer someone with hypertension
Severe HPT
Complications
Secondary cause
RHT
Progressive target organ damage
Comorbidities
Emergency/Urgency
Labile HPT
Methods to control blood pressure
Medication
Lose weight (BMI 18,5 - 24,9)
Dietary changes (more fruit + veg, less cereals and starchy roots, less sodium, more whole grain and legumes)
Drink mainly water
Avoid alcohol (no more than 2 drinks a day)
exercise 30 min a day, 5 days a week
Stop smoking
Medication used to treat hypertension
3 classes of HPT drugs:
1) RAAS blockade (e.g. ACE inhibitors and Angiotensin receptor blockers – never prescribe together!)
2) Calcium channel blockers
3) Diuretics (thiazide and thiazide- like – prefer the latter)
In SA, prefer using 2 and 3 together as first line treatment in black patients
Indications for certain HPT medications
Fluid overload: Diuretics (Loop, thiazide)
Ischaemic heart disease: Spironolactone, Calcium channel blocker, ACE inhibitor, beta blocker
Vascular disease: Calcium channel blocker
Diabetes mellitus: ACE inhibitor, ARB
