Hypertension Flashcards
Define Hypertension
> 140mmHg/90mmHg on more than two occasions. or >135mmHg/85mmHg with 24hr ECG.
Hypertension’s role in Cardiovascular disease
Hypertension leads to sheering forces in the vessels. leads to development of Atherosclerotic disease.
Causes hypertrophy of Left ventricle and can lead to heart failure.
Causes of Hypertension
Primary (Essential) hypertension has no cause
Secondary Causes: Conn’s syndrome, Cushings, Phaeochromocytoma, Acromegaly, hyperparathyroidism.
Renal vascular disease -
Malignant hypertension is a rapid increase in BP that causes vascular damage.
Diagnosis of Hypertension
If >140mmHg/90mmHg then further investigations needed. Second visit and measurement.
24hour/Ambulatory BP measurement used. If >135mmHg/85mmHg then Stage 1, If >150/95mmHg Stage 2.
Presentation of hypertension
Asymptomatic.
Malignant hypertension may present with headache and visual disturbances.
Retinopathy - flame haemorrhages, cotton wool spots, copper wiring.
LVH.
Signs of Renal disease.
Investigation of HTN
BP recognises incidental findings. then 24hour/Ambulatory BP.
Opthalmoscope to look at retina’s can indicate any complications.
ECG for signs of LVH, Echo for LVH
Bloods: BM, Cholesterol, U+Es for kidney function, low K+ (Conn’s), Renin:aldosterone levels, Ca++ + PTH, metanephrines (phaeo) cortisol levels.
Urine dip
Management of Hypertension.
Reduce risks of CVD - smoking, glucose, cholesterol, salt restriction.
Treat underlying causes - Endocrine/Renal disease.
Aim<130/80.
Then proceed to monotherapy, then combination.
Pharmacological treatment.
If 55yr/Afro - Ca blocker/Thiazide diuretic.
Then add in.
If dual therapy not improving add beta blocker/spironolactone. Do not give beta blockers with Ca blocker.