Hypertension Flashcards
What is the BP for Grade 1 HTN? (diagnosed with HTN)?
140-159/90-99 mmHg
What is the BP for Grade 2 HTN and above? (diagnosed with HTN)?
≥ 160/100 mmHg
What is the BP for high-normal BP?
≥ 130-139/85-89 mmHg
At what BP should action be taken?
≥ 130/85 mmHg
How to calculate pt’s 10 year CV risk if no risk factors for CVD?
Singapore-modified Framingham Risk Score (SG-FRS-2023)
What is the benefit of lowering SBP by 5 mmHg?
Lowers risk of major CV events by 10%
What is the benefit of lowering SBP by 10 mmHg and DBP by 5 mmHg?
Lowers risk of heart disease, stroke, coronary heart disease, CV mortality and all-cause mortality
What is considered high to very high CV risk and what is the target BP?
Pts with CVD, CKD, DM or HMOD (hypertension-mediated organ damage) OR risk score >20%
< 130/80 mmHg
What is considered low to intermediate CV risk and what is the target BP?
Pts with no risk factors OR risk score ≤ 20%
< 140/90 mmHg (can go lower as tolerated)
Which group of patients should have target BP of < 150/90 mmHg (less stringent)?
- older age (>80y)
- frail
- orthostatic hypotension
- limited life expectancy
Should the target BP be < 120/70 mmHg? Why?
No, evidence of benefit beyond this threshold is inconsistent & potential for increased risk of SE can lead to tx discontinuation
What are some lifestyle interventions of elevated BP?
- DASH diet (fruits, veg, low-fat dairy products, reduce saturated & total fat)
- reduce Na intake
- alcohol consumption moderation
- increased physical activity
- weight reduction if overweight/obese
- smoking cessation
What is hypertension-mediated organ damage (HMOD)? Examples?
Structural / functional changes in arteries or end organs (e.g. heart, brain, eyes, kidneys, blood vessels)
E.g. left ventricular hypertrophy, albuminuria, hypertensive retinopathy
When to start pharmacotherapy for pts with elevated BP?
- high-normal BP with high to very high CV risk (presence of relevant conditions or risk score >20%) esp if not controlled after 3-6m
- grade 1 HTN with low to intermediate CV risk (risk score ≤20%) esp if risk score 10-20% or BP not controlled after 3-6m
- grade 1 HTN with high to very high CV risk (presence of relevant conditions or risk score >20%)
- grade 2 HTN and above with any CV risk
What are the 1st lines for HTN?
- ACEi
- ARB
- DHP-CCB
- thiazide/thiazide-like diuretics
Why are thiazide/thiazide-like diuretics considered alternative 1st lines?
Due to SE
- hyperglycaemia
- hyperuricemia
- increased urination
- electrolyte derangements (hypoK, hypoNa, hyperCa)
- hypotension, dizzy
- photosensitivity
What are some meds that can cause HTN (secondary)?
NSAIDs, steroids, decongestants, diet pills, COC, stimulants
What is considered major CV events?
- fatal / non-fatal stroke
- fatal / non-fatal MI or IHD
- HF causing death or hospital adm
How does dry cough happen when using ACEi?
ACEi inhibits breakdown of bradykinin -> causes dry cough
What triggers juxtaglomerular (JGA) cells to release renin?
- reduced pressure -> smooth muscle cells less stretched -> sensed by JGA cells
- reduced pressure -> sensed by vasomotor centre -> activate SNS -> activate JGA cells via renal nerves
- reduced pressure -> less fluid filtration & reabsorption -> sensed by macula densa cells -> signal to JGA cells via paracrine communication
Where are juxtaglomerular cells found?
In juxtaglomerular apparatus located next to glomerulus, all in the nephron
What is the MOA of renin?
Cleave angiotensinogen into angiotensin-1 (partially active)
How is angiotensin-II formed?
Angiotensinogen cleaved by renin to angiotensin-I, which is cleaved by ACE into angiotensin-II
What does angiotensin II act on to maintain BP?
- arterioles -> vasoconstrict -> increase BP
- CV control center in medulla oblongata -> increase CV response -> increase BP
- hypothalamus -> increase thirst & increase ADH -> increase water intake & reduce water excretion -> increase vol, maintain osmolarity -> increase BP
- adrenal cortex -> increase aldosterone -> increase Na reabsorption by kidneys -> increase vol, maintain osmolarity -> increase BP
