Hypertension Flashcards
What is the NICE guideline definition of hypertension?
Hypertension is diagnosed with a blood pressure above 140/90 in a clinical setting, confirmed with ambulatory or home readings above 135/85.
What is essential hypertension?
Essential (or primary) hypertension accounts for 90% of cases and occurs without a known secondary cause.
What does the “ROPED” mnemonic stand for in secondary causes of hypertension?
R – Renal disease
O – Obesity
P – Pregnancy-induced hypertension or pre-eclampsia
E – Endocrine
D – Drugs (e.g., alcohol, steroids, NSAIDs)
What are common complications of hypertension?
Complications include:
* Ischaemic heart disease
* Stroke
* Peripheral arterial disease
* Hypertensive retinopathy
* Hypertensive nephropathy
* Vascular dementia
* Left ventricular hypertrophy
* Heart failure
What is left ventricular hypertrophy, and how can it be diagnosed?
Left ventricular hypertrophy occurs when the left ventricle thickens due to increased resistance. It can be diagnosed with ECG voltage criteria or an echocardiogram.
How often should blood pressure be measured to screen for hypertension?
Blood pressure should be measured every 5 years, more often in borderline cases, and every year in patients with type 2 diabetes.
What is ‘white coat syndrome’?
White coat syndrome occurs when a patient’s blood pressure is higher in the clinical setting than in ambulatory or home readings, typically more than 20/10 mmHg higher.
What is the NICE recommended way to measure blood pressure in both arms?
Blood pressure should be measured in both arms, and if the difference is more than 15 mmHg, use the higher reading.
What are the stages of hypertension according to NICE?
Stage 1: Clinic >140/90, Ambulatory >135/85
Stage 2: Clinic >160/100, Ambulatory >150/95
Stage 3: Clinic >180/120
What tests should be done for end-organ damage in new hypertension patients?
Tests include:
* Urine albumin:creatinine ratio
* Dipstick for haematuria
* HbA1c
* Renal function
* Lipids
* Fundus examination for retinopathy
* ECG for cardiac abnormalities
What is the QRISK score, and when should statins be considered?
The QRISK score estimates the 10-year risk of stroke or myocardial infarction. If the score is above 10%, a statin (e.g., atorvastatin 20mg) should be offered.
What lifestyle changes are recommended for managing hypertension?
Recommendations include:
* Healthy diet
* Stopping smoking
* Reducing alcohol
* Reducing caffeine
* Reducing salt intake
* Taking regular exercise
What are the classes of medications used in hypertension management?
Classes include:
* A – ACE inhibitor (e.g., ramipril)
* B – Beta blocker (e.g., bisoprolol)
* C – Calcium channel blocker (e.g., amlodipine)
* D – Thiazide-like diuretic (e.g., indapamide)
* ARB – Angiotensin II receptor blocker (e.g., candesartan)
How does the treatment of hypertension differ for patients under 55, over 55, or with type 2 diabetes?
Under 55 or type 2 diabetic: Start with an ACE inhibitor (A).
Over 55 or Black African: Start with a calcium channel blocker (C).
Step 2 (both groups): A + C, or A + D, or C + D.
Step 3: A + C + D.
Step 4: A + C + D + additional agent (depending on potassium levels).
What is the significance of potassium levels in hypertension treatment?
Potassium ≤ 4.5 mmol/L: Consider potassium-sparing diuretic (e.g., spironolactone).
Potassium > 4.5 mmol/L: Consider alpha blocker (e.g., doxazosin) or beta blocker (e.g., atenolol).
What are the treatment targets for hypertension?
Under 80 years: Systolic <140, Diastolic <90
Over 80 years: Systolic <150, Diastolic <90
What defines a hypertensive emergency (malignant hypertension)?
Hypertensive emergency involves blood pressure >180/120 with retinal haemorrhages or papilloedema. Immediate referral is required for fundoscopy and assessment of end-organ damage.
What intravenous treatments are used in a hypertensive emergency?
Intravenous treatments include:
* Sodium nitroprusside
* Labetalol
* Glyceryl trinitrate
* Nicardipine, guided by an experienced specialist.
