Hypertension Flashcards
What is the blood pressure range for normal levels?
Between 90/60 - 140/90 mmHg
What is the clinic BP for Stage 1 hypertension?
140/90 mmHg +
What is the ABPM daytime average for Stage 1 hypertension?
135/85 mmHg +
What is the clinic BP for Stage 2 hypertension?
160/100 mmHg +
What is the ABPM daytime average for Stage 2 hypertension?
150/95 mmHg +
What is the threshold for Stage 3 hypertension that requires immediate treatment?
Systolic > 180 mmHg or diastolic > 120 mmHg
What are the two types of hypertension?
Primary (essential) Hypertension and Secondary Hypertension
What is the most common type of hypertension?
Primary (essential) Hypertension
What are common symptoms of hypertension?
Usually asymptomatic; can include headaches, visual disturbances, seizures
What is one method used to diagnose hypertension?
BP cuff
What does 24-hour ambulatory blood pressure monitoring help avoid?
‘White coat syndrome’
How many measurements should be taken during 24-hour ABPM?
At least 14 measurements
2 measurments per hour between 8:00-22:00
What should be done if there is a difference in blood pressure readings of more than 20mmHg between arms?
Subsequent measurements should be in the higher arm
Nam the investigations done for newly diagnosed hypertension?
- Fundoscopy: hypertensive retinopathy
- Urine dip + U&E: renal disease (either cause or consequences)
- ECG: check for lLV hypertrophy or IHD
- HbA1c: check for DM
- Lipid: check for hyperlipidaemia
What should be checked with a urine dip for newly diagnosed hypertension?
Renal disease
What does ECG check for in hypertension investigations?
Left ventricular hypertrophy or ischemic heart disease
What is the management approach for Stage 1 hypertension?
Treat if aged 80+ AND organ damage/CVD risk (Q risk > 10%)
What is the management approach for Stage 2 hypertension?
Offer drug treatment regardless of age
What is the first line of treatment for hypertension?
- Lifestyle modifications
- Low salt dier
- Stop smoking, drink less, good diet, exercise more, loose weight
What is the recommended daily salt intake for hypertension management?
Less than 6g/day (ideally 3g/day)
What type of diuretic is spironolactone + moa?
- Potassium-sparing diuretic
- MOA: competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule —> causes increased amounts of sodium and water to be excreted, while potassium is retained.
When should a statin be offered to hypertensive patients?
If the patient’s Q-RISK3 > 10%
True or False: For patients of black African or African-Caribbean origin, an ACE inhibitor is preferred over an angiotensin receptor blocker.
False
What are two complications of hypertension?
Stroke and Ischaemic heart disease
What are the clincial aims of BP management?
Name one renal disease that can cause secondary hypertension.
Glomerulonephritis
What is the most common endocrine disorder associated with secondary hypertension?
Primary hyperaldosteronism/Conn’s syndrome
Name one drug that can cause secondary hypertension.
Steroids
What are some other causes of secondary hypertension?
Pregnancy, coarctation of the aorta
MOA of Thiazide-like diuretics
MOA: Inhibiting the sodium-chloride (Na/Cl) cotransporter in the distal convoluted tubule (DCT), leading to increased sodium and water excretion, and consequently, a reduction in blood volume and blood pressure.
Outline the drug treatment for hypertension for 1st, 2nd and 3rd line management
Outline the 4th line management for hypertension
Measure K+
If K+ < 4.5 –> Add Low dose Spironalactone
If K+ > 4.5 –> Add a or b blocker
