Hypertension Flashcards
NICE guideline for ACE-i initiation kidney function drop
eGFR drop NOT > 25%
Creatinine NOT raised by 30%
old/black
Who should start on CCB for HTN?
Age > 55 + black/afro
young/white
Who should start on ACE-i for HTN?
Age < 55 + NOT afro/black
Afro/carribean w/ T2DM or proteinuria
ARBs
1st-4th lines
HTN Mx for < 55
1st: ACE-i
2nd: ACE-i + CCB
3rd: ACE-i + CCB + THz like (Indapamide)
4th:
if K+ < 4.5 add Spironolactone (MR Antagonist)
if K+ > 4.5 add Doxazosin (alpha-1 blocker) OR Atenolol (Beta-1 adrenergic blocker)
HTN Mx for > 55 + Afro/carribean
- CCB
- CCB + ACE-i/ARB
- CCB + ACE-i/ARB + THZ like (Indapamide)
- if K+ < 4.5 add Spironolactone (MR Antagonist)
if K+ > 4.5 add Doxazosin (alpha-1 blocker) OR Atenolol (Beta-1 adrenergic blocker)
Amlodipine SEs
- Ankle oedema
- Angiodema
- Gum hypertrophy
HTN Staging
1: >140/90 + ABPM 135/85
2: >160/100 + ABPM 150/95
3: >180/120
When to offer HMBP?
When ABPM is unable to tolerate
Orthostatic BP diagnosis
> 20 systolic BP drop when measuring LSBP
How to measure LSBP?
Measure BP at supine position, then measure standing BP after 1min standing
When to offer ABPM?
Clinical BP is 140/90 - 180/120
HMBP requirements
- 2 consecutives BP readings
- Morning + Evening
- 7 days
Total 28 readings
When to refer to same-day specialist?
180/120 w/ retinopathy OR life-threatening Sx
What to do with people with BP 180/120 w/ no Sx for same day referral?
- Carry out Ix for end-organ damage
- if damage identified: stat Tx
- if NO organ damage: repeat BP in 7days
