Hypertension Flashcards
What should be done if there is a difference of more than 15 mmHg in blood pressure readings between arms?
Measure subsequent blood pressures in the arm with the higher reading.
How should blood pressure be measured in people with postural hypotension?
Measure blood pressure while the person is supine or seated, and again after they stand for at least 1 minute. If systolic pressure falls by 20 mmHg or more when standing, measure subsequent blood pressures with the person standing.
What is systolic pressure?
Systolic pressure is the pressure when the heart pushes blood out around the body.
What is diastolic pressure?
Diastolic pressure is the pressure when the heart rests between beats and blood is pushed around the heart.
What are the target clinic blood pressures for individuals under 80 years old?
Clinic blood pressure should be below 140/90 mmHg; ABPM/HBPM should be below 135/85 mmHg.
What are the target clinic blood pressures for individuals aged 80 and older?
Clinic blood pressure should be below 150/90 mmHg; ABPM/HBPM should be below 145/85 mmHg.
What is Ambulatory Blood Pressure Monitoring (ABPM)?
ABPM is a 24-hour test where blood pressure is measured continuously using a portable device worn on the waist and a cuff on the arm.
What should you do when the ABPM device is about to take a reading?
Sit down if possible, keep the cuff at heart level, keep your arm still, and avoid talking or crossing your legs.
What are the two types of hypertension?
Primary Hypertension (no identifiable cause) and Secondary Hypertension (caused by conditions like kidney disease or endocrine disorders).
What are the diagnostic criteria for hypertension?
Blood pressure readings of 140/90 mmHg or higher or sustained diastolic blood pressure of 90 mmHg or more. Confirmation with ABPM or HBPM is needed.
What are the risk factors for hypertension?
Age, gender, ethnicity (especially black African/Caribbean descent), family history, lifestyle factors (smoking, alcohol, poor diet, lack of exercise), and stress.
What is Stage 1 hypertension?
Clinic blood pressure ranging from 140/90 mmHg to 159/99 mmHg, with subsequent ABPM/HBPM averages ranging from 135/85 mmHg to 149/94 mmHg.
What is Stage 2 hypertension?
Clinic blood pressure of 160/100 mmHg or higher but less than 180/120 mmHg, with subsequent ABPM/HBPM averages of 150/95 mmHg or higher.
What is Stage 3 (severe) hypertension?
Clinic systolic blood pressure of 180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher.
What lifestyle changes are important for managing hypertension?
Improve diet (limit sodium), exercise, reduce alcohol and caffeine, quit smoking, and manage stress.
What should be checked during an annual review for hypertension management?
Renal function (creatinine, electrolytes, eGFR, and albumin:creatinine ratio) and reassessment of cardiovascular risk.
What is the first-line treatment for people under 55 years of age and not of black African or African-Caribbean family origin?
Offer an ACE inhibitor or ARB (angiotensin-II receptor antagonist).
What is the preferred treatment for people of black African or African-Caribbean family origin who have type 2 diabetes?
Offer an ARB (angiotensin-II receptor antagonist) in preference to an ACE inhibitor.
What should be done if an ACE inhibitor is not tolerated?
Offer an ARB (angiotensin-II receptor antagonist) instead.
What should be avoided when treating hypertension with ACE inhibitors or ARBs?
Do not combine an ACE inhibitor with an ARB.
What is the first-line treatment for people aged 55 years or over who do not have type 2 diabetes?
Offer a calcium-channel blocker (CCB).
What should be offered first-line for people of black African or African-Caribbean family origin without type 2 diabetes?
Offer a calcium-channel blocker (CCB).
What should be done if a calcium-channel blocker (CCB) is not tolerated?
Offer a thiazide-like diuretic, such as indapamide.
What should be offered if there is evidence of heart failure and the patient needs antihypertensive treatment?
Offer a thiazide-like diuretic, such as indapamide.
What is preferred when starting or changing diuretic treatment for hypertension?
Offer a thiazide-like diuretic, such as indapamide, in preference to a conventional thiazide diuretic like bendroflumethiazide or hydrochlorothiazide.
What should be done for people already on bendroflumethiazide or hydrochlorothiazide with stable, well-controlled blood pressure?
Continue with their current treatment.
What should be discussed before considering the next step of treatment if hypertension is not controlled with step 1 treatment?
Discuss adherence to the prescribed treatment.
What should be added if hypertension is not controlled with an ACE inhibitor or ARB in step 1 treatment?
Offer a choice of either a calcium-channel blocker (CCB) or a thiazide-like diuretic.
What should be added if hypertension is not controlled with a calcium-channel blocker (CCB) in step 1 treatment?
Offer a choice of either an ACE inhibitor or ARB (prefer an ARB for those of black African or African-Caribbean family origin) or a thiazide-like diuretic.
What combination should be offered in step 3 if hypertension is not controlled with step 2 treatment?
Offer a combination of an ACE inhibitor or ARB, a calcium-channel blocker (CCB), and a thiazide-like diuretic.
What treatment should be considered for people with confirmed resistant hypertension and a blood potassium level of 4.5 mmol/L or less?
Consider further diuretic therapy with low-dose spironolactone, with caution for those with reduced renal function.
What should be done for people with a blood potassium level of more than 4.5 mmol/L and resistant hypertension?
Consider an alpha-blocker or beta-blocker.
