Hypertension Flashcards
What is the difference between primary and secondary hypertension?
Primary Hypertension: No identifiable cause.
Secondary Hypertension: Caused by an underlying medical condition.
Stage 1 Hypertension clinic BP vs average BP range for hypertension (ABPM/HBPM)
Clinic BP: 140/90 mmHg to 159/99 mmHg
ABPM/HBPM Average Blood Pressure: 135/85 mmHg to 149/94 mmHg
Stage 2 Hypertension clinic BP vs average BP range for hypertension (ABPM/HBPM)
Clinic BP: 160/100 mmHg to < 180/120 mmHg
ABPM/HBPM Average Blood Pressure: ≥ 150/95 mmHg
Stage 3 Hypertension clinic BP vs average BP range for hypertension (ABPM/HBPM)
Clinic BP: ≥ 180/120 mmHg
ABPM/HBPM Average Blood Pressure: Not specified (clinic values used).
Risk factors for hypertension?
Age: BP increases with age.
Gender: Women have lower BP until 65, then higher.
Ethnicity: Higher risk in Black African and Caribbean populations.
Genetics: Family history and genetic factors contribute.
Social Deprivation: Higher risk in deprived areas.
Co-existing Conditions: Diabetes, kidney disease increase risk.
Lifestyle: Smoking, alcohol, high salt, poor diet, obesity, inactivity.
Stress: Anxiety and stress can raise BP.
Stepwise approach
Start with one antihypertensive, then add others if control isn’t achieved. Titrate to the highest tolerated dose before adding
new drugs.
Isolated sytolic hypertension
Treat similarly to combined systolic and diastolic hypertension if systolic BP ≥160 mmHg.
Ethnicity consideration for hypertensive treatment
For Black African/Caribbean individuals, prefer ARBs over ACE inhibitors.
Pregnancy considerations for hypertensive treatment
ACE inhibitors and ARBs should be avoided during pregnancy, breastfeeding, or planning pregnancy unless essential.
What is the recommended Step 1 treatment for hypertension in individuals under 55 years old and not Black African/Caribbean with Type 2 diabetes?
(1st line) ACE Inhibitor/ARB
What should you do if an ACE inhibitor causes a cough?
Switch to an ARB
What is the Step 1 treatment for individuals over 55 years old or Black African/Caribbean (without Type 2 diabetes)?
(1st line) Calcium Channel Blocker (CCB)
What can be used if a CCB is not suitable or causes oedema?
(1st line) A thiazide-like diuretic (e.g., indapamide)
What is the recommended Step 2 treatment if Step 1 does not control blood pressure?
(2nd line) Add CCB or thiazide-like diuretic
What should you check if ACE or ARB does not control BP in Step 1?
Ensure optimal dose and adherence
What is the recommended Step 3 treatment for hypertension?
Combination of ACE/ARB, CCB, and thiazide-like diuretic
What should you consider if BP remains uncontrolled after Step 3?
Confirm resistance with ambulatory/home BP monitoring, add spironolactone (if potassium ≤ 4.5) or alpha/beta-blocker (if potassium > 4.5)
What is the recommended action for resistant hypertension?
Seek specialist advice if BP remains uncontrolled after 4-drug therapy
Why should ACE inhibitors and ARBs be avoided during pregnancy?
Increased risk of congenital abnormalities.
When should ACE inhibitors/ARBs be stopped if pregnancy is confirmed?
Within 2 days of pregnancy confirmation.
What should be discussed with patients taking thiazide diuretics who are planning pregnancy?
Risks of congenital abnormalities and neonatal complications.
Is there evidence that other antihypertensive drugs increase the risk of congenital malformations?
No, limited evidence shows no increased risk.
What is the target blood pressure for managing chronic hypertension in pregnancy?
135/85 mmHg.
What are the preferred antihypertensives in pregnancy?
Labetalol or nifedipine.
What should be used if Labetalol or nifedipine are unsuitable for hypertension in pregnancy?
Methyldopa
What dose of aspirin should be offered for pre-eclampsia prevention, and when should it start?
75 mg to 150 mg daily from 12 weeks.
When should PLGF-based testing be offered to rule out pre-eclampsia?
Between 20–36 weeks if pre-eclampsia is suspected.
What are some typical causes of drug-induced hypertension?
Sodium Retention / Volume Expansion (increased fluid, increased BP)
Sympathetic Nervous System Activation (can cause vasoconstriction, increasing BP)
Arteriolar Smooth Muscle Constriction (constrict smooth muscle, raise BP)
Discontinuation of Medications Causing Hypotension
Management of drug-induced hypertension
Discontinue the Causative Agent
Specific Therapy and Dose Adjustment
Symptoms of hypertension
severe headaches.
chest pain.
dizziness.
difficulty breathing.
nausea.
vomiting.
blurred vision or other vision changes.
anxiety.
