Hypertension Flashcards
What are the risk factors for Hypertension?
- Age
- Ethnicity
- Dietary salt
- Exercise
- Alcohol
- Caffeine
- Smoking
- Obesity
What are the secondary causes for hypertension?
- Renal Disease
- Endocrine Disease
High blood pressure can cause organ damage, to which organs?
- Heart
- Brain
- Kidneys
- Eyes
- Blood vessels
What are the hypertension thresholds?
Stage 1 hypertension:
Clinical - 140/90 – 160/100
Ambulatory - 135/85
Stage 2 hypertension:
Clinical - 160/100 – 180/120
Ambulatory - 150/95
What are the next steps for someone with no hypertension and no target organ damage?
Measure clinic BP every 5 years (or more frequently if close to 140/90mmHg)
What are the next steps for someone with no hypertension and target organ damage present?
Investigate causes of organ damage
What are the next steps for someone with hypertension?
Lifestyle interventions, drug treatment, investigate if organ damage is present
Which patients with stage 1 hypertension require treatment?
- They are under 60 with an estimated 10-year CVD risk of >10%
- They are aged 80 or over
OR
They are under the age of 80 with one or more of the following:
* Target organ damage
* Established CVD
* Renal disease
* Diabetes
* 10-year CVD of >10%
If patient is under 40 with no target organ damage, further investigations must be done to determine the cause of the hypertension.
What are the next steps for patients with stage 2 hypertension?
Treatment is required, regardless of age
What drugs are used in hypertension?
- Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)
- Angiotensin-II Receptor Blockers (ARBs)
- Calcium Channel Blockers (CCBs)
- Thiazide Diuretics
- Low-dose Spironolactone
- Alpha Blockers
- Beta Blockers
What are the next steps for patients with severe hypertension?
Treat promptly with IV antihypertensive
When must patients with hypertension be referred?
If they have severe hypertension with any of the following signs:
* Retinal haemorrhage
* Papilledema (accelerated hypertension)
* Life threatening symptoms (e.g. new onset confusion, chest pain, signs of heart failure)
* Suspected phaeochromocytoma (e.g. postural hypotension, headache, palpitations, abdominal pain, pallor)
What are the treatment steps for patients with Hypertension with type 2 diabetes?
Step 1: ACE Inhibitor (or ARB)
Step 2: ACE Inhibitor (or ARB) + Calcium Channel Blocker
Step 3: ACE inhibitor (or ARB) + Calcium Channel Blocker + Thiazide Diuretic
Step 4:
Confirm resistant hypertension, confirm elevated BP with ABPM or HBPM, check for postural
hypertension and discuss adherence. Consider adding:
- Low-dose spironolactone if blood potassium levels <4.5mmol/L.
- Alpha blocker if blood potassium levels >4.5mmol/L.
Seek expert advice if BP remains uncontrolled on optimal tolerated doses of 4 drugs
What are the treatment steps for patients less than 55 years of age and NOT of Black African or Afro-Caribbean, with hypertension and without type 2 diabetes?
Step 1: ACE Inhibitor (or ARB)
Step 2: ACE Inhibitor (or ARB) + Calcium Channel Blocker
Step 3: ACE inhibitor (or ARB) + Calcium Channel Blocker + Thiazide Diuretic
Step 4:
Confirm resistant hypertension, confirm elevated BP with ABPM or HBPM, check for postural
hypertension and discuss adherence. Consider adding:
- Low-dose spironolactone if blood potassium levels <4.5mmol/L.
- Alpha blocker if blood potassium levels >4.5mmol/L.
Seek expert advice if BP remains uncontrolled on optimal tolerated doses of 4 drugs
What are the treatment steps for patients more than 55 years old, with hypertension and without type 2 diabetes?
Step 1: Calcium Channel Blocker
Step 2: Calcium Channel Blocker + ACE Inhibitor (or ARB)
Step 3: ACE inhibitor (or ARB) + Calcium Channel Blocker + Thiazide Diuretic
Step 4:
Confirm resistant hypertension, confirm elevated BP with ABPM or HBPM, check for postural
hypertension and discuss adherence. Consider adding:
- Low-dose spironolactone if blood potassium levels <4.5mmol/L.
- Alpha blocker if blood potassium levels >4.5mmol/L.
Seek expert advice if BP remains uncontrolled on optimal tolerated doses of 4 drugs
What are the treatment steps for patients of Black African or Afro-Caribbean descent of any age, with hypertension and without type 2 diabetes?
Step 1: Calcium Channel Blocker
Step 2: Calcium Channel Blocker + ACE Inhibitor (or ARB)
Step 3: ACE inhibitor (or ARB) + Calcium Channel Blocker + Thiazide Diuretic
Step 4:
Confirm resistant hypertension, confirm elevated BP with ABPM or HBPM, check for postural
hypertension and discuss adherence. Consider adding:
- Low-dose spironolactone if blood potassium levels <4.5mmol/L.
- Alpha blocker if blood potassium levels >4.5mmol/L.
Seek expert advice if BP remains uncontrolled on optimal tolerated doses of 4 drugs
What is the treatment plan for hypertension in type 1 diabetes?
Step 1: ACE inhibitor
Step 2: Beta blocker
Step 3: Low-dose thiazide Diuretic
Step 4: Calcium channel blocker (only long-acting preparations)
What is the target blood pressure for pregnant women?
<135/85mmHg
What is the treatment steps for hypertension in pregnancy?
1st Line: Labetalol
2nd Line: Nifedipine (Modified-release)
3rd Line: Methyldopa
What are the hypertension targets for various conditions?
CKD – <130/80mmHg
Type 1 diabetes with albuminuria or features of metabolic syndrome – <130/80mmHg
Pregnancy – <135/85mmHg
Type 1 diabetes – <135/85mmHg
Same day specialist referral – >180/120mmHg
What is the mechanism of action for ACE Inhibitors?
Inhibit the conversion of angiotensin-I into angiotensin-II
What are examples of ACE inhibitors?
Examples: ramipril, lisinopril, captopril, enalapril, perindopril, fosinopril etc
What are the side effects of ACE inhibitors?
First-dose hypotension, angioedema, persistent dry cough
What is the mechanism of action for Angiotensin receptor blockers?
Block the binding of angiotensin
