Hypertension Flashcards

0
Q

What causes hypertension?

A

Essential hypertension: idiopathic

Secondary:
Renal disease - glomerulonephritis, poly arthritis nodosa, PKD, renovascular
Endocrine - cushings, conns, phaeocytochroma, acromegaly
Pregnancy
NSAIDs
Recreational drugs

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1
Q

How often should adults have their blood pressure checked?

A

At least every 5 years

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2
Q

What are risk factors for hypertension?

A
Age
African/Caribbean ethnicity
High salt diet
Obesity
Smoking
Drinking large amounts of alcohol
Family history 
Sedentary lifestyle
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3
Q

What investigations may help to explore secondary causes of hypertension?

A

24 hour urinary metanephrines/catecholamines - if primary hyperaldosteronisms eg conns, phaeo

Urinary free cortisol/dexamethasone suppression test - cushings

Renin aldosterone levels - conns

Plasma calcium - increased in hyperparathyroidism

MRI/USS of renal arteries - renal artery stenosis

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4
Q

How is hypertension diagnosed in clinic?

A

BP >140/90

Severe hypertension is BP >180/110

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5
Q

How is BP diagnosed at home?

A

Stage 1 - BP >135/85

Stage 2 - BP >150/92

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6
Q

How is ambulatory blood pressure monitoring carried out?

A

Recommended if clinic test shows high BP

Measured 2x an hour 24 hours (or at least 14 readings)

Each recording done twice, at least 1 min apart

Use automated BP device

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7
Q

How is home blood pressure monitoring carried out?

A

If ABPM not tolerated

Two consecutive measurements taken, twice daily, in morning and evening

For at least four days, ideally seven days

Discard readings for day 1 and take an average value for the rest

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8
Q

What investigations should be done for target organ damage and formal assessment of cardiovascular risk?

A

Qrisk2

Urine analysis - ACR, haematuria

Bloods - cholesterol, HDL, UandEs, eGFR, plasma glucose, HBa1c

Examine fundi for retinopathy

12 leads ECG

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9
Q

Should Qrisk2 be used if a patient with hypertension has DM or Cardiovascular disease?

A

Qrisk2 is not necessary on this case as the patient has already justified treatment or lifestyle interventions

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10
Q

What lifestyle interventions should be recommended to patients with hypertension?

A
Increases exercise
Diet - base meals on starchy foods, ear fruit
Reduce alcohol
Reduce salt intake
Smoking cessation
Group support initiatives
Relaxation therapies
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11
Q

When should anti hypertensives be offered in hypertension?

A

If BP >140/90
Under 80

And:
Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk equivalent to 20% or greater (qrisk2)
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12
Q

What if stage 2 hypertension after ambulatory monitoring?

A

Offer anti hypertensives!

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13
Q

What is first line treatment for hypertensive patients under 55 and Caucasian?

A

Ace inhibitor

Ramipril 2.5mg OD

Or lisinopril, peripril

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14
Q

What is the first line treatment for patients over 55 or black person of African/Caribbean descent?

A

Calcium channel blocker

Amlodipine 5mg OD

Others: felodipine, nifedipine

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15
Q

What are the contraindications/cautions for ACEI?

A

High dose diuretics
Unstable heart disease
Known renovascular disease
High dose vasodilators

16
Q

What are the side effects of ACEI?

A

Dry cough
Hyperkalaemia
Impaired renal function

Renal artery stenosis

17
Q

How should ACEis be used?

A

Check UandEs before starting

Recheck UandEs after 1-2 weeks
Monitor UandEs regularly throughout treatment

Take first one at night to avoid hypotension

Review patient and recheck BP in 4 weeks

Offer ARB if ACEI not tolerated

18
Q

What are the side effects of calcium channel blockers?

A
Ankle swelling
Headaches
Flushing
Nausea
These may reduce after a few days

Monitor - bring back in two weeks

19
Q

What is the second step in hypertensive management?

A

Try on both ACEI and calcium channel blocker

20
Q

What is the third step?

A

Add in thiazides like diuretic

Indapamide or bendroflumethiazide

21
Q

How should a thiazides diuretic be started?

A

Indapamide 2.5mg OD in the morning

Less effective if eGFR <30mls

Side effects:
GI disturbance
postural hypotension
Hypokalaemia
Hyponatraemia
22
Q

What is the fourth step?

A

Consider specialist advice

Add in:
Spironolactone
Alpha blocker
Beta blocker

23
Q

How should spironolactone be started?

A

Start spironolactone 25mg OD

Caution if high potassium levels and low eGFR

Side effects:
GI disturbances
Hyperkalaemia