Hypertension Flashcards
NICE definition of hypertension
persistent elevated BP over 140/90
Causes of hypertension
primary hypertension has no known cause
secondary hypertension - renal, endocrine, vascular disorder or the use of certain drugs.
diagnosis of hypertension
usually asymptomatic
detected via routine screening
misdiagnosis with clinic/office monitoring due to white coat hypertension and poor sensitivity of equipment and specificity.
NICE (2019) recommendations for hypertension
multiple clinic/ office BP measurements over or same as 140/90mmHg
ABPM/HBPM over or same as 135/85mmHg
clinical classifications of hypertension
according to BP level - mild, moderate or severe
according to target organ damage - traditional classification grade 1-3
NICE (2019) stage 1-3
what factors influence BP?
age, sex, ethnicity, temporal variation of BP in some individuals.
epidemiology and natural history of hypertension
complications
- symptomless in initial stages
associated with increased CVD risk due to TOD
CVD risk doubles with each BP increment of 20/10 mmHg
increasing evidence of link with high risk of AF, cognitive decline and dementia
additive/synergistic effect with other CVD risk factors.
known causes of secondary hypertension
renal
endocrine
pregnancy
drugs
renal cause of secondary hypertension
polycystic kidney disease
renal artery stenosis
endocrine cause of secondary hypertension
conns syndrome, high aldesterone
cushings syndrome, high Glucocorticoids
acromegaly, high growth hormone excess.
pregnancy cause of secondary hypertension
Pre-eclampsia & eclampsia
drugs cause of secondary hypertension
oestrogens (combined oral contraception)
NSAID
steroids like corticoids
pathophysiological characteristics of primary hypertension
persistently ↑ BP in systemic arteries, diastolic always over 90mmHg.
no known causes
↑ total peripheral resistance
cardiac output is usually normal but can be high in some stages
altered renal physiology
hyper reactivity of BP to stress
TOD of hypertension
(look at pp for more info)
cerebrovascular disease
hypersensitive retinopathy
left ventricular disease
CAD
CKD
peripheral artery disease
practical clinical definitions of hypertension
level of BP which is associated with increased morbidity and
mortality at some future time, when compared with the whole
population’
‘level of BP at which treatment does more good than harm’
‘level of BP above which intervention has been shown to reduce
cardiovascular risk‘
‘level of BP at which the benefits of treatment (either with
lifestyle interventions or drugs) unequivocally outweigh the risks
of treatment, as documented by clinical trials’
what are the two definitions of hypertension?
sustained or persistent elevated arterial BP
dividing line between ‘normotensive’ &’hypertensive’ is arbitrary, based on associated CV risk, based on arbitrarily defined ‘normal’ BP levels
why is there no precise definition for hypertension?
normal, not bimodal, distribution of BP among populations ‘normal’ increase in BP with age wide temporal variations in BP in same individuals BP also a function of gender & race
pharmacological treatments for hypertension
ACEI
ARB
CCA
Diuretics
Beta blockers
miscellaneus
non pharmacological treatment for hypertension
lifestyle modification
less salt intake
who and when to treat hypertension?
NICE
adults of any age with persistent stage 2 HPT (BP is or above 160/100 mmHg)
Adults aged under 80 with persistent Stage 1 HPT, plus one or more of
target organ damage
existing / established CVD
renal disease
diabetes
an estimated 10-year CVD risk is or above 10%
Adults aged under 60 with Stage 1 HPT and an estimated 10-year CVD
risk <10%
Adults aged over 80 with a clinic blood pressure of over 150/90 mmHg
