Hypertension Flashcards
Essential HTN
Primary HTN with no underlying cause
Causes of Secondary HTN
Renal Disease - most common
Obesity
Pre-eclampsia
Endocrine - Conn’s Syndrome
Drugs - alcohol, steroids, NSAIDS, Oestrogen and liquorice
White coat syndrome
White Coat Syndrome : >20/10 difference in BP between clinic and ambulatory or home readings.
Screening for HTN
Screened every 5 years. More often in borderline cases and every year in T2DM
Measure in both arms and use the reading with the higher pressure.
Ix for HTN
24 ambulatory blood pressure or home readings if clinic BP is >140/90
If >180/120 screen for end organ damage if asymptomatic
Send for Urgent assessment in hospital if symptomatic.
End organ damage in new HTN diagnosis
Urine albumin : creatinine ratio for proteinuria
Dipstick for haematuria
Blood - HbA1c, renal function and lipids
Fundus examination - hypertensive retinopathy
ECG - cardiac abnormalities including LVH.
ABPM
at least 2 measurements per hour during the person’s usual waking hours (for example, between 08:00 and 22:00)
use the average value of at least 14 measurements
HBPM
for each BP recording, two consecutive measurements need to be taken, at least 1 minute apart and with the person seated
BP should be recorded twice daily, ideally in the morning and evening
BP should be recorded for at least 4 days, ideally for 7 days
discard the measurements taken on the first day and use the average value of all the remaining measurements
Stage 1 HTN
Clinic >140/90 and home >135/85
Stage 2 HTN
Clinic >160/100 and home >150/95
Stage 3 / Malignant HTN
Clinic >180/120
When to treat Stage 1 HTN
<60 and QRISK <10%
< 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater
When to use CCB 1st line
If in afro caribbean family origin,
over 55
Normal 1st line treatment HTN
ACE / ARB
HTN Treatment algorithms
A or C
A+C OR A+D OR C+D
A+C+D
A+C+D + additional.
Serum potassium =<4.5mmol/L - potassium sparing diuretic
Serum potassium >4.5mmol/L - Alpha blocker or Beta Blocker.
Target for HTN treatment
Under 80 = <140/90
Over 80 = <150/90
Secondary prevention of HTN
QRISK >10% = statin (normally atorvastatin 20mg at night)
Healthy diet
Smoking cessation
Reducing alcohol, caffeine and salt intake
Complications HTN
IHD
Cerebrovascular accident
Vascular disease or dementia
Hypertensive retinopathy or nephropathy
LV Hypertrophy
Heart Failure.
HTN Emergency
> 180/120 with retinal haemorrhages or papilloedema
Management HTN Emergency
Same day referral with fundoscopy and assessment for secondary causes
IV options:
Sodium nitroprusside
Labetalol
Glyceryl trinitrate
Nicardipine
