Hypertension Flashcards
what is hypertension?
is defined as persistently elevated arterial blood pressure
what is primary hypertension?
where no identifiable cause is found
what is secondary hypertension?
where an underlying cause exists
what is accelerated or malignant hypertension?
severe increase in blood pressure to ≥180/120mmHg, and often higher, associated with signs of retinal haemorrhages and/or papilloedema on fundoscopy
what is white-coat hypertension?
exists only when blood pressure is measured during medical consultations with a discrepancy of >20/10mmHg between clinic blood pressure measurements and ambulatory or home blood pressure measurements
what are the risk factors for hypertension?
- sex (e.g. up to 65 years women tend to have lower blood pressures than men, however, between the ages of 65-74 years women tend to have higher blood pressures)
- ethnicity (e.g. black african, black caribbean)
- age
- lifestyle (e.g. smoking, alcoholism, excess dietary salt intake, sedentary)
what are the red flag symptoms of accelerated or malignant hypertension?
- headache
- visual disturbances
- seizures
- nausea
- vomiting
- chest pain
what are the investigations for hypertension?
- fundoscopy (e.g. hypertensive retinopathy)
- BP (e.g. ABPM, HBPM)
- urinalysis
- uACR
- ECG
- U&Es
- HbA1C
- HDL/LDL
when can ambulatory blood pressure monitoring (ABPM) be offered?
if the patient’s blood pressure is between 140/90mmHg and 180/120mmHg offer ABPM or HBPM to confirm the diagnosis of hypertension
what is QRISK3?
a tool used to estimate the 10-year risk of developing cardiovascular disease (CVD) in individuals between 25 and 84 years old
what is the target blood pressure for patients aged <80 years?
a clinic blood pressure <140/90mmHg or ABPM/HBPM <135/85mmHg
what is the target blood pressure for patients aged ≥80 years?
a clinic blood pressure <150/90mmHg or ABPM/HBPM <145/85mmHg
when should antihypertensive drug therapy be discussed or considered in patients with stage 1 hypertension?
- a patient <80 years who has: CVD, kidney disease, or a ≥10% QRISK3
- a patient ≥80 years with BP >150/90 mmHg
- a patient <60 years with <10% QRISK3
what is the recommendation for antihypertensive drug therapy in stage 2 and 3 hypertension?
offer antihypertensive drug therapy to all patients
what is the first step of the medical management of hypertension?
- <55 + not of black african/african-caribbean descent: ACEi (e.g. ramipril) or ARB (e.g. losartan)
- ≥55 or of black african/african-caribbean descent: CCB (e.g. amlodipine)
what is the second step of the medical management of hypertension?
- if already taking an ACEi or ARB: CCB or a thiazide-type diuretic (e.g. indapamide)
- if already taking a CCB: ACEi or a thiazide-type diuretic
what is the third step of the medical management of hypertension?
offer a combination of an ACEi or ARB plus a CCB and a thiazide-type diuretic
what is the fourth step of the medical management of hypertension?
- serum potassium ≤4.5mmol/l: offer low-dose spironolactone
- serum potassium of >4.5mmol/L: offer an alpha-blocker (e.g. doxazosin) or a beta-blocker (e.g. atenolol)
what is the recommended management for patients with a clinic BP of ≥180/120mmHg, according to NICE?
refer for same-day specialist assessment if there are:
- signs of retinal haemorrhage and/or papilloedema on fundoscopy
- life-threatening symptoms (e.g. new-onset confusion, chest pain, signs of HF, or AKI)
if none of the above are present, investigate for signs of complications:
- if complications are present, start medical management without waiting for ABPM/HBPM
- if no complications are present, repeat BP measurements within 7 days
what are the key management steps for patients with accelerated or malignant hypertension requiring hospital admission?
- arterial line
- IV antihypertensive (e.g. nitroprusside, labetalol, nicardipine)
what are the long-term complications of hypertension?
- brain (e.g. stroke, vascular dementia)
- eye (e.g. hypertensive retinopathy)
- heart (e.g. CAD, PVD, cardiac arrhythmia, HF)
- kidney (e.g. CKD)
