Hypertension Flashcards
What blood pressure is classed as hypertensive in clinic?
140/90 or greater
What blood pressure is classed as hypertension at home / not measured by doctor/ using ABPM?
135/85 or greater
What is the most common cause of secondary hypertension?
CKD as result of diabetic nephropathy
What are other common causes of secondary hypertension?
Endocrine conditions like Pheochromocytoma
Conn’s disease
Cushing’s disease
Pregnancy
What are risk factors for hypertension?
Age
Black ethnicity
Overweight
Lack of exercise
Smoking
Diabetes
Stress
Increased salt intake
Family history
What is stage 1 hypertension?
Over 140/90 mmHg in clinic
or
over 135/85 mmHg at home
What is stage 2 hypertension?
Over 160/100 mmHg in clinic
or
over 150/95 mmHg at home
What is stage 3 hypertension?
Over 180/110 mmHg
What causes hypertension?
Increased RAAS and SNS activity increase CO and TPR (Total Peripheral Resistance)
Increased CO and TPR = Increased bp
BP = CO x TPR
True or false: hypertension is most often asymptomatic, may have pulsatile headache
True
True or false: malignant hypertension is caused by cancerous malignancies creating an inflammatory reaction
False
Nothing to do with cancer, just causes very acute severe symptoms
What are symptoms of malignant hypertension (acute and severe)?
Heart failure (LVH)
Blurred vision (papilledema, retinal haemorrhage)
Haematuria and renal failure (glomerulonephritis)
Headache, risk of cerebral haemorrhage
How is hypertension diagnosed?
BP reading in hospital being 140/90+ mmHg
then ABPM to for 24 hours to confirm diagnosis (bp of 135/85 throughout day)
Assess end organ damage
How is end organ damage assessed?
Fundoscopy for papilledema
Urinalysis, eGFR, serum creatinine and glucose for renal function and diabetes risk
ECHO/ECG for LVH
What is the first step in treatment for hypertension if younger than 55 or has T2 diabetes?
ACE-inhibitor
(contraindicated if on ARB)
What is the first step in treatment of hypertension in patients over 55 or black African patients?
CCB
What group of patients would be prescribed ACE-i initially to treat hypertension?
Those under 55
Those with T2DM
What group of patients would be prescribed CCB initially to treat hypertension?
Those aged 55+
Black Africans
What would be the initial treatment for hypertension in a 66 y/o Black African man with T2 diabetes?
ACE-i
(T2DM trumps age or being Black African)
What is the 2nd stage in treatment for hypertension?
ACE-i and CCB
What is the 3rd stage in treatment for hypertension?
ACE-i and CCB and thiazide like diuretic or thiazide (less potent)
Thiazide-like diuretic = Indapamide
Thiazide: Bendroflumethiazide
What is the 4th stage in treatment for hypertension?
ACE-i + CCB + TLD + 4th drug depending on potassium levels
If K+ more than 4.5 then alpha or beta blocker
If K+ less than 4.5 then spironolactone (K+ sparing)
Name all drugs given by the 4th stage of treatment for hypertension for a patient with K+ of 3.0
Ramipril (ACEi)
Amlodipine (CCB)
Indapamide (Thiazide-like diuretic)
Spironolactone
Name all drugs given by the 4th stage of treatment for hypertension for a patient with K+ of 5.0
Ramipril (ACE-i)
Amlodipine (CCB)
Indapamide (TLD)
Atenolol (B-blocker)
What are complications of hypertension?
Heart failure
Increased IHD risk
CKD
Increased risk of cerebrovascular accident
