Hypertension Flashcards
Hypertension stages
Stage 1: CBP 140/90 + ABPM or HBPM > 135/85
Stage 2: CBP > 160/100 + ABPM or HBPM > 150/95
Stage 3/severe: > 180/120
Accelerated/malignant HTN
Severe increase in BP to > 180/120 with signs of:
- retinal haemorrhage +/or papilloedema
- usually associated with TOD
White coat HTN
15-30%
> 20/10mmHg discrepancy between clinic and ABPM or HBPM at diagnosis
Masked HTN
Clinic BP < 140/90 but BP higher on HBPM or ABPM
RFs for HTN
1) Age
2) < 65y -men, 65-74y -women
3) African and black Caribbean
4) FH
5) Social deprivation
6) DM, CKD
7) Smoking, alcohol, salt, diet, obesity, lack of exercise
8) anxiety and stress
Most common cause of secondary HTN
Renal disorders:
1) CKD - most common cause
2) Chronic pyelonephritis
3) DM nephropathy - proteinuria
4) Glomerulonephritis - haematuria
5) PCKD - mass, haematuria, FH
6) Obstructive uropathy -mass
7) Renal cell carcinoma - haematuria, loin pain, mass
Other causes:
1) Vascular:
- coarctation of the aorta
- renal artery stenosis
2) Endocrine:
- Primary hyperaldosteronism: most common curable cause of HTN
- phaeochromocytoma
- Cushing’s syndrome
- Acromegaly
- Hypothyroidism: increased diastolic BP
- Hyperthyroidism: increased systolic BP
3) Drugs:
- Alcohol: most common individual secondary cause of HTN
- ciclosporin
- cocaine, amphetamine, stimulants
- COCP / HRT
- steroids
- liquorice
- NSAIDs
- venlafaxine
4) Other conditions:
- pregnancy
- SLE, scleroderma, PAN
- OSA
Coarctation of aorta findings
1) Difference in BP R & L arm
2) Absent/weak femoral pulses
3) R-F delay
40 suprasternal murmur radiating to back
Renal artery stenosis findings
1) History of PVD
2) Abdominal bruit
3) BP resistant to treatment
4) Raised renin
Primary hyperaldosteronism
Most common curable cause of HTN
Adrenal adenoma
Presentation:
1) HypoK, raised bicarbonate (alkalosis), Na > 140 or larger than expected decrease in K when using thiazide diuretic
2) Tetany, muscle weakness, nocturia, polyuria
3) CCB can mask features
Phaemochromocytoma
Presentation:
1) Intermittently high or labile BP
2) Postural hypotension
3) Headaches
4) Sweating attacks, diaphoresis
5) Palpitations
6) Unexplained fever or abdominal pains
7) or asymptomatic
Can become malignant or have catastrophic haemorrhage
Risks reduced for every 10mmhg reduction in BP
1) 17% reduction in CHD
2) 27% reduction in stroke
3) 28% reduction in heart failure
4) 13% reduction in all cause mortality
5% reduction in systolic BP reduces risk of major CVE by 10% even at normal BP
Measuring clinic BP
If difference in BP > 15mmHg between both arms x 2, then measure BP on highest arm
Automated devices may give inaccurate measurement if pulse irregularity therefore always feel pulse first
If symptoms of postural hypotension and drop in 20mmHg on standing for 1 minute, then measure subsequent BPs standing
ABPM
2 measurements/hour during waking hours
Use average of at least 14 measurements
HBPM
For each recording, 2 consecutive measurements at least 1 minute apart, twice daily.
4-7 days
Discard first day of measurements
BP > 180/120
Same day specialist assessment:
- accelerated HTN (retinal haemorrhage/papilloedema)
- life-threatening symptoms: new onset confusion, chest pain, signs of HF or AKI
No symptoms:
- **urgent investigations for TOD **
- consider starting antihypertensive drug without waiting for ABPM/HBPM result
- if no TOD identified, repeat BP in 7 days
