Hypertension Flashcards
What is Primary Hypertension?
High blood pressure as a result of environmental or genetics causes.
What is Secondary Hypertension?
High blood pressure as a result of multiple systemic causes such as pregnancy, obstructive sleep apnoea, renal, vascular and endocrine causes.
-CKD
-Diabetic nephropathy
-Renal Cell Carcinoma
-Coarctation (narrowing) of Aorta (heart to body)
-Acromegaly
-Hypothyroidism
-Drugs - Cocaine, Alcohol, Erythropoietin (EPO)
What is Hypertension?
It is persistently raised arterial blood pressure. It is defined as systolic blood pressure of 140mHg or more or a diastolic blood pressure of 90mmHG or more.
What is the pathophysiology of high BP?
It is multifactorial and complex where systems involving blood viscosity, cardiac output, blood vessel elasticity is affected by genetic predisposition, excess salt intake and adrenergic tone (autoregulation)
What is malignant hypertension?
It is a severe increase of BP to 180/120mmHg or higher and often over 220/120 mmHg with signs of retinal haemorrhage, papilledema, and new/end organ damage.
What is white-coat hypertension?
It is a BP that is raised in clinical scenarios but normal in regular scenarios. There is usually an increase of 20/10 mmHg.
Masked Hypertension is the opposite where clinic BP is normal but higher when in regular environments.
What risk factors make you more prone to get hypertension?
Age - Advancing Age
Gender - Up to 65Y women have lower BP then men
Ethnicity - Black African and Caribbean origin are more likely to get this
Genetics
Social Deprivation
Lifestyle - smoking, alcohol, salt intake, obesity
Anxiety and Stress - increased adrenaline and cortisol levels
What are the investigations for Hypertension?
Assess for target organ damage
Haematuria (Blood in urine)
Proteinuria
Hba1C
U/Es
ECG for cardiac function and Left ventricular hypertrophy
Serum cholesterol
QRISK score for 10 year risk of development
Management for Hypertension?
Malignant Hypertension = Same day specialist referral
If not = Lifestyle advice like diet, excercise, caffeine intake, salt intake, smoking, alcohol.
Stage 1+2 Hypertension of >140/90 + 160/80-180/120 mmHg = antihypertensive drugs + Lifestyle advice
What is isolated hypertension?
It is when the diastolic BP is 80 or less but a systolic BP or 130mmHg or higher.
What are the drug treatments ?
ACE inhibitor or ARB (angiotensin-2 receptor antagonist for people aged under 55 and not black.
- Enalapril or Ramipril (ACE)
IF NOT TOLERATED BC of COUGH USE:
- Candesartan, Losartan, Telmisartan (ARB)
DO NOT COMBINE BOTH.
Offer Calcium channel blockers
-Amlodipine
-Nifedipine
-Veramipril
for aged 55 years or older and do not have T2 diabetes, are black, and if NOT TOLERATED BC of oedema USE:
thiazide-like diuretic such as indapamide (decreases sodium reabsorption and decreases fluid reabsorption)(salt causes water retention)
Not controlled:
Step 2: ACE/ARB + CCB OR THIAZIDE-LIKE DIURETIC
Step 3: ACE/ARB + CCB + THIAZIDE-LIKE DIURECTIC
Step 4: Resistant and seek specialist advice
What is iatrogenic induced hypertension?
This high BP caused by drugs such as caffeine, decongestants, steroids, NSAIDS and immunosuppressants.
