Hypertension Flashcards
What is hypertension?
A persistent elevation of BP with values above 140/90 on two separate occasions.
What is the most accurate method for confirming hypertension?
Ambulatory blood pressure monitoring where there is continuous measurement over a 24 hour sleep/wake cycle. Prior to taking BP, patient should e seated for at least 5 mins and cuff should cover 80% of arm.
What should a patient do before measuring blood pressure?
Be seated for at least 5 minutes and ensure the cuff covers 80% of the arm.
What are the two main types of hypertension?
- Essential hypertension
- Secondary hypertension
Define essential hypertension.
No identifiable cause, linked to family history, obesity, and lifestyle. There is impaired response to RAAS and increased activation of sympathetic nervous system, which increases peripheral resistance and afterload.
Typically, patients will be asymptomatic and are diagnosed incidentally, or at later stages, may present with symptoms of end-organ damage.
What characterizes secondary hypertension?
Induced by other co-morbidities.
What is Stage 1 hypertension?
BP reading of 140/90.
What is Stage 2 hypertension?
BP reading of 160/100.
What is Stage 3 hypertension?
BP reading of 180/120, requiring same-day referral for investigation. this can be either systolic or diastolic value. With this reading, ambulatory blood pressure is not required and it should be immediately escalated.for same day referral to investigate for signs of target organ damage. If target organ damage is identified, begin antihypertensive drug treatment
-> this includes retinal haemorrhage
Papilloedema (swelling of the optic nerve)
New onset confusion, chest pain, signs of heart failure or kidney injury
What are signs of target organ damage in hypertension?
- Retinal hemorrhage
- Papilloedema
- New onset confusion
- Chest pain
- Signs of heart failure or kidney injury
What is accelerated/malignant hypertension?
Severe increase in BP to 180/120 mmHg or higher with grade 3/4 retinopathy. Patients may present with a headache, visual disturbances and findings include proteinuria and haematuria. This is a medical emergency that requires immediate treatment to prevent rapid progression to renal failure, heart failure or stroke.
What are common causes of malignant hypertension?
- Medication noncompliance
*hypoperfusion and ischaemia - Renovascular disease
- Use of amphetamines
- Head injury
- Cerebral infarction or hemorrhage
What symptoms may patients with malignant hypertension present?
- Headache
- Visual disturbances
- Proteinuria
- Hematuria
What is masked hypertension?
Normal BP in clinic but elevated BP outside of clinic.
What is the protocol for diagnosing hypertension?
Measure blood pressure in both arms; if readings differ by more than 15 mmHg, use the higher reading.
What should be done for BP readings between 140/90 and 180/120?
Offer ambulatory blood pressure monitoring.
What is the confirmed diagnosis of hypertension?
Clinic BP of 140/90 and ABPM average of 135/85 mmHg.
What evaluations should be completed for signs of end-organ damage?
- 12 lead ECG
- Fundoscopy
- FBC for creatinine, eGFR, and albumin-creatinine ratio
- Carotid Doppler ultrasound
What is the ideal method to assess peripheral arterial disease?
Ankle brachial pressure index is ideal to assess for peripheral arterial disease by comparing blood pressure in the upper and lower limbs by dividing ankle blood pressure from arm blood pressure
What factors can affect the accuracy of BP measurement?
- Distended bladder
- Unsupported back/arm
- Recent meal intake
- Caffeine and nicotine use
- Wrong cuff size
- Insufficient time between measurements
What is the white coat effect?
Higher BP of 20/10 mmHg at clinics compared to home BP.
What are the types of eye damage caused by hypertension?
- Retinopathy
- Choroidopathy
- Ischaemic optic neuropathy
- Retinal vascular occlusion
What are the types of eye damage caused by hypertension?
The eye has auto regulation of blood flow, absence of sympathetic norerve supply and blood-retinal barrier. Therefore excessive increase in BP causes damage to muscle layer and endothelium. There is a vasoconstriction phase, sclerotic phase, exudative phase where final haemorrhage, hard exudates form, necrosis of smooth muscle and Cotton wool spots from retinal ischaemia.
Patients may present with double vision, dimmed vision and headaches, hwoever symptoms do not occur until the late stages.
Describe Grade I retinopathy?
Tortuous arteries with thickened bright walls.
