Hypertension Flashcards
Chronic elevation in BP (systolic ≥140 mmHg or diastolic ≥90 mmHg)
Hypertension
systolic ≥140 mmHg
Hypertension
In HT systolic is …..
≥140 mmHg
In HT diastolic is …..
≥90 mmHg
diastolic ≥90 mmHg
Hypertension
more common in some ethnic groups, particularlyAfrican Americans and Japanese
Hypertension
Systolic BP < 120
Optimal
Systolic BP < 130
Normal
Systolic BP 130 - 139
High normal
Systolic BP 140 - 159
Grade 1 (mild) HT
Systolic BP 160 - 179
Grade 2 (moderate) HT
Systolic BP ≥ 180
Grade 3 (severe) HT
diastolic BP < 80
Optimal
diastolic BP = 85
Normal
diastolic BP 85 - 89
High normal
diastolic BP 90 - 99
Grade 1 (mild) HT
diastolic BP 100 - 109
Grade 2 (moderate) HT
diastolic BP > 110
Grade 3 (severe) HT
systolic 140 - 159 mmHg and diastolic < 90 mmHg
Isolated systolic HT grade 1
systolic ≥ 160 mmHg and diastolic < 90 mmHg
Isolated systolic HT grade 2
HT types (4)
White-coat hypertension
Primary or essential hypertension
Secondary hypertension
Malignant or accelerated phase hypertension
elevated BP when measured at a health care provider’s office , but normal ABPM (day average <135/85)
White-coat hypertension
more likely to develop hypertension in future, and may have the risk of CVD
White-coat hypertension
ABPM
Ambulatory BP monitoring - 24hr
more than 95% of cases of HT
Essential hypertension
no specific underlying cause can be found for HT
Essential hypertension
patients who develop hypertension at an early age with or without a positive family history.
Secondary hypertension
patients who first exhibit hypertension when over age 50 years
Secondary hypertension
patients previously well-controlled now become refractory to treatment.
Secondary hypertension
Approximately 5% of patients with hypertension
Secondary hypertension
hypertension have specific causes
Secondary hypertension
Alcohol
Cause of 2ry HT
Obesity
Cause of 2ry HT
Renal disease
Cause of 2ry HT
Endocrine disease (slides)
Cause of 2ry HT
Drugs
Cause of 2ry HT
Coarctation of aorta
Cause of 2ry HT
rapid rise in BP leading to vascular damage
Malignant or accelerated phase hypertension
pathological hallmark is fibrinoid necrosis
Malignant or accelerated phase hypertension
Usually there is severe hypertension (eg systolic >200, diastolic>130mmHg)
+ bilateral retinal haemorrhages and exudates
Malignant or accelerated phase hypertension
Papilloedema may or may not be present
Malignant or accelerated phase hypertension
may precipitate acute kidney injury, heart failure, or encephalopathy
Malignant or accelerated phase hypertension
It is more common in younger and in black subjects
Malignant or accelerated phase hypertension
Due to old age:↓Elasticity and ↓compliance of the large blood vessels resulting in ↑ SYSTOLIC BP
Isolated Systolic Hypertension
60% of hypertensives > 80 years old
Isolated Systolic Hypertension
Usually asymptomatic (except in malignant)
HT
Radiofemoral delay, or weak femoral pulses (coarctation)
Renal bruits, palpable kidneys
Cushing’s syndrome
Signs of renal disease
Signs of renal disease
HT
Radiofemoral delay,
HT
weak femoral pulses (coarctation)
HT
Renal bruits
HT
palpable kidneys
HT
Cushing’s syndrome
HT
Retinopathy and proteinuria
HT
end-organ damage
HT
Renal dysfunction is a factor which may cause ……
HT
Peripheral resistance is a factor which may cause ……
HT
Vascular tone is a factor which may cause ……
HT
Endothelial dysfunction is a factor which may cause ……
HT
Autonomic tone is a factor which may cause ……
HT
Age
Risk factor of HT
High salt intake
Risk factor of HT
Obesity
Risk factor of HT
Lack of exercise
Risk factor of HT
Impaired intrauterine growth and low birth weight
Risk factor of HT
All with BP ≥160/100mmHg
Need to be treated
BP ≥140/90 with risk of coronary events
Need to be treated
BP ≥140/90 with presence of diabetes
Need to be treated
BP ≥140/90 with end-organ damage
Need to be treated
Management of HT
antihypertensive therapy
(Slides)
Urinalysis for Blood, protein and glucose
HT investigation
Blood urea, electrolytes and creatinine
HT investigation
Blood glucose
HT investigation
Serum total and HDL cholesterol
HT investigation
Thyroid function tests
HT investigation
12-lead ECG (L. Ventricular hypertrophy, coronary artery disease)
HT investigation
Chest X-ray
To detect …. (3)
Cardiomegaly, heart failure, coarctation of aorta
Ambulatory BP recording
To assess
Borderline/ white-coat HT
Echocardiogram
To detect or quantify
L ventricular hypertrophy
Renal ultrasound
To detect …..
Possible renal disease
Renal angiography
To detect or confirm ……
Presence of renal artery stenosis
Urinary catecholamines
To detect …
Possible pheochromocytoma
Urinary cortisol + dexamethasone suppression test
To detect ….
Possible Cushing’s syndrome
Plasma renin activity + aldosterone
To detect
Possible primary aldosteronism
HT treatment goal
<140/90 mmHg
HT treatment goal in diabetes
<130/80 mmHg
HT treatment goal if aged > 80
150/90 mmHg
In HT BP should be reduced slowly why?
rapid reduction can be fatal, especially in the context of an acute stroke
Lifestyle changes in HT (5)
Stop smoking
Low-fat diet , ↑ vegetables and fruits and low-fat diet
Reduce alcohol and salt intake
Regular exercise
Reduce weight if obese.
Diuretics
HT treatment drug
Beta Blockers/Alpha-blockers
HT treatment drug
Calcium channel blockers
HT treatment drug
ACE-i or ARB
HT treatment drug
Aldosterone antagonists
HT treatment drug
Vasodilators
HT treatment drug
