Hypertension Flashcards
What is hypertension?
Hypertension is persistently elevated blood pressure, defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg in clinic measurements.
What are the classifications of hypertension?
It is classified as primary (essential) or secondary, with primary hypertension being more common.
What is the difference between primary and secondary hypertension?
Primary hypertension has no identifiable cause, while secondary hypertension is due to an underlying condition, such as renal disease or endocrine disorders.
What are the common symptoms of hypertension?
Hypertension is often asymptomatic but can cause headaches, dizziness, visual disturbances, or symptoms related to complications.
What is the aetiology of primary hypertension?
It is multifactorial, involving genetic predisposition, lifestyle factors, and environmental influences.
What are the common causes of secondary hypertension?
Causes include renal artery stenosis, chronic kidney disease, endocrine disorders (e.g., Cushing’s syndrome, hyperaldosteronism), and medications like NSAIDs.
What is the pathophysiology of hypertension?
It involves increased systemic vascular resistance and/or cardiac output, often due to factors like endothelial dysfunction, overactivation of the RAAS, or sympathetic nervous system hyperactivity.
What are the risk factors for hypertension?
Age, obesity, high salt intake, sedentary lifestyle, excessive alcohol consumption, smoking, and a family history of hypertension.
What is the prevalence of hypertension in the UK?
It affects around one-third of adults in the UK, with prevalence increasing with age.
How is blood pressure measured in diagnosing hypertension?
Blood pressure is measured in both arms, and ambulatory or home BP monitoring is recommended to confirm the diagnosis.
What is the role of ambulatory blood pressure monitoring (ABPM) in hypertension?
ABPM provides multiple BP readings over 24 hours, helping to confirm hypertension and detect white coat or masked hypertension.
What investigations are performed in a patient with newly diagnosed hypertension?
Blood tests (e.g., U&Es, lipid profile, glucose), urinalysis, ECG, and fundoscopic examination to assess for target organ damage.
What are the clinical signs of target organ damage in hypertension?
Signs include left ventricular hypertrophy (ECG), retinopathy (fundoscopy), proteinuria (urinalysis), and chronic kidney disease.
What are the differential diagnoses for hypertension?
White coat hypertension, masked hypertension, and secondary causes like pheochromocytoma or renal artery stenosis.
What are the complications of untreated hypertension?
Complications include stroke, myocardial infarction, heart failure, chronic kidney disease, and hypertensive retinopathy.
What is the first-line treatment for hypertension in patients under 55 years of age?
An ACE inhibitor (e.g., ramipril) or an angiotensin receptor blocker (ARB) if ACE inhibitors are not tolerated.
What is the first-line treatment for hypertension in patients aged over 55 or of African/Caribbean descent?
A calcium channel blocker (e.g., amlodipine) is preferred.
What lifestyle modifications are recommended for managing hypertension?
Reducing salt intake, maintaining a healthy weight, increasing physical activity, moderating alcohol consumption, and following a DASH diet.
What is resistant hypertension, and how is it managed?
Resistant hypertension is BP that remains uncontrolled despite three antihypertensive agents. It is managed by optimising therapy and investigating secondary causes.
How is hypertensive urgency different from hypertensive emergency?
Hypertensive urgency involves severely elevated BP without target organ damage, while hypertensive emergency involves target organ damage (e.g., encephalopathy, acute renal failure).
How is hypertensive emergency managed?
It is managed with intravenous antihypertensive medications (e.g., labetalol, nitroprusside) and careful BP monitoring to avoid rapid drops.
What is the target blood pressure for patients with hypertension?
< 140/90 mmHg in clinic settings or < 135/85 mmHg with home or ambulatory monitoring. Lower targets may be recommended for high-risk patients.
What is white coat hypertension?
It refers to elevated blood pressure readings in a clinical setting but normal readings outside of it, often due to anxiety.
Why is patient education important in managing hypertension?
Educating patients improves adherence to lifestyle changes and medication, reducing the risk of complications.
