Hypertension Flashcards
hypertension blood pressure
how common
risk factor for…
> =140/90mmHg
50% of >60 years
stroke, myocardial infarction, heart failure
‘silent killer’
causes of primary hypertension(90-95%)
family history
obesity
excess salt in diet
excess alcohol intake
causes of secondary hypertension(5-10%)
reno(vascualr)
endocrine
coarctation of aorta
pregnancy induced
exogenous hormones
possible consequences of not diagnosing and treating hypertension
can lead to heart attack, stoke or end-stage renal failure
how to measure blood pressure
sphygmomanometer- rubber cuff on arm connected to column of mercury attached to graduating scale. determines BP by increasing and releasing pressure in cuff
types of manual BP devices
aneuroid sphygmomanometer
mercury sphygmomanometer
types of automated BP devices
digital monitor- general use
ambulatory monitor- portable
‘waiting room’ BP monitor- GP surgery
steps for taking BP
choose correct cuff size
patients sit and rest for 5 mins
place their arm at heart level
make sure they dont talk or move while taking BP
How to use manual monitors
palpate brachial artery
inflate cuff until palpations disappears
deflate cuff
inflate to 30 more than pressure when palpation disappeared
place stethoscope on brachial artery and deflate slowly until hear tapping sound
measure systolic and diastolic
Diagnosis and investigation of hypertension
> 140/90mmHg clinical BP
135/85 ABPM BP
if this is case record again, if vastly different take a third and only record lower of last 2 readings
also offer ambulatory blood pressure monitoring
if cant handle ABPM offer home blood pressure monitoring
severe hypertension
BP(systolic)>=180 or BP(diastolic)>=120
start antihypertensiondrug treatment ASAP
as if left untrated can lead to end organ damage
factors that suggest hypertension
clinical BP 140/90mmHg or higher with HBPM 135/85 or higher
stage 1- clinical BP>=140/90 and BP<=159/99
stage 2 BP>=160/100
investigations
-target organ damage: urinanalysis, ECG, fundoscopy
-secondary causes: MR renal angiogram, plasma renin, aldesterone levels, endocardiogram
treatment
lifestyle intervention- weight loss (diet and exercise)
target BMI 20-25
reduce alcohol intake
reduce caffine intake
reduce salt intake
treat secondary causes- adrenal tumor surgery
antihpertension drug therapy- depends on age, ethnicity, reactivity
Ace inhibitors
Beta blockers
Calcium channel blockers
Diuretics
what drug to choose
depends on age, ethnicity, previous adverse reaction
A(B)CD method to decide
ACE inhibitors/ angiotensin receptor blocker
beta blockers
calcium channel blocker
diuretics