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Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what is essential hypertension?

A

a rise in blood pressure of unknown cause that increase risk for cerebral, cardiac and renal events

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2
Q

what did the Framingham study assess?

A

the risk of coronary heart disease, stroke and heart failure in a 36 year follow up of patients aged 35-64

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3
Q

for individuals aged 40-69 years old, when does CV mortality risk double?

A

with each 20/10 mmHg

increased to blood pressure

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4
Q

what is hypertension?

A

the level of blood pressure where the treatment does more good than harm

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5
Q

how do you confirm the diagnosis of hypertension if the clinic BP is 140/90 mmHg or higher?

A

offer ambulatory blood pressure monitoring

ABPM

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6
Q

how do you confirm the diagnosis of hypertension if the clinic BP is 140/90 mmHg or higher but the patient is unable to tolerate ABPM?

A

home blood pressure monitoring (HPBM)

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7
Q

when would you start an anti-hypertensive drug solely on the clinic BP results, without waiting for the result of ABPM or HBPM?

A

if the patient has severe hypertension
(clinic SBP is 180mmHg+
or clinic DBP is 110mmHg+)

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8
Q

to confirm a diagnosis, what readings must you ensure the ABPM has got?

A

at least 2 measurements per hour during waking hours

14 days usually

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9
Q

to confirm a diagnosis, what readings must you ensure the HBPM has got?

A

2 consecutive measurements, 1 minute apart
BP recorded for at least 4 days (7 days preferred)
[measurements on the first day are discarded]

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10
Q

if hypertension is not diagnosed, how often do you want to measure the person’s clinic blood pressure?

A

at least every 5 years

even more frequently if their clinic BP is nearing 140/90mmHg

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11
Q

what is state 1 hypertension?

A

clinic BP is 140/90 mmHg or higher
AND
ABPM or HBPM daytime average is 135/85 or higher

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12
Q

what is state 2 hypertension?

A

clinic BP is 160/100 or higher
AND
ABPM is 150/95

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13
Q

what is severe hypertension?

A

clinic systolic BP is 180mmHg or higher
OR
clinic diastolic BP is 110mmHg or higher

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14
Q

for all patients with diagnosed hypertension what 4 extra tests should you offer during the diasnosis stage?

A
  • test urine for presence of protein
  • take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholestero
  • examine fundi for hypertensive
  • 12 lead ECG
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15
Q

when measuring estimated CV risk what BP value should you use?

A

clinic BP

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16
Q

what is the % CV risk that diabetes gives?

A

20%+

17
Q

what is the main driver of absolute CV risk?

A

age

18
Q

what is the % CV risk that established vascular disease gives?

A

> 20%

19
Q

what is Grade I of the KWB classification of hypertensive retinopathy?

A

slight or modest narrowing of the retinal arterioles with the arteriovenous ratio >_ 1:2

20
Q

what is grade II of the KWB classification of hypertensive retinopathy?

A

modest to severe narrowing of the retinal arterioles (focal or generalised) with an arteriovenous ratio below 1:2 or with arterial nicking

21
Q

what is the grade III KWB classification of hypertensive retinopathy?

A

bilateral soft exudates or flame-shaped haemorrhages

22
Q

what is the grade IV KWB classifiaction of hypertensive retinopathy?

A

bilateral optic nerve oedema

23
Q

if a patient over 40 has stage 1 hypertension what is the management?
[CBPM 140/90mmHg or greater AND HBMP 135/85mmHg or greater]

A

lifestyle interventions

24
Q

if a patient under 55 has stage 2 hypertension what is the step 1 management?

[CBMP 160/100mmHg or greater AND HBPM 150/95mmHg or greater]

A

anti hypertensive drug treatment with ACE inhibitor

or ARB if ACE is not tolerated well

25
Q

what should you never combine an ACE with to treat hypertension?

A

ARB

26
Q

if a patient over 55 has stage 2 hypertension what is the step 1 management?

[CBPM 160/100mmHg or greater AND HBMP 150/95mmHg or greater]

A

anti hypertensive drug treatment with calcium antagonist

if calcium antagonisr not suitable use thiazide diuretic

27
Q

if a patient is of African or Caribbean family origin (any age) and has stage 2 hypertension what is the step 1 management?

[CBPM 160/100mHg or greater AND HBPM 150/95mmHg]

A

anti hypertensive drug treatment with calcium antagonist

if calcium antagonist not suitable use thiazide-diuretic

28
Q

why might a calcium antagonist not be suitable for treatment of stage 2 hypertension in a patient over 55 or of black/caribbean origin?

A

oedema
heart failure
not tolerated

29
Q

if a patient under 55 has stage 2 hypertension that is not controlled by step 1 treatment, what is the management?

[CBMP 160/100mmHg or greater AND HBPM 150/96mmHg or greater]

A

step 2:
add on a calcium antagonist with the step 1 ACE/ARB

(if calcium antagonist not suitable use thiazide diuretic)

30
Q

if a patient is of African or Caribbean family origin (any age) and has stage 2 hypertension that isn’t controlled with step 1 treatment, what is the management?

[CBPM 160/100mHg or greater AND HBPM 150/95mmHg]

A

step 2:

add on a ARB with the step 1 calcium antagonist/thiazide diuretic

31
Q

what are the aims of hypertension drug treatment in a patient under 80?

A

CBPM 140/90 mmHg

32
Q

what are the aims of hypertension drug treatment n a patient over 80?

A

CBPM 150/90 mmHg

33
Q

what percentage of BP variability is genetically determined?

A

30-50%

34
Q

what type of lifestyle advice do you give to a person with stage 1 hypertension?

[CPBM 140/90mmHg and APBM/HPBM average 135/85mmHg]

A
  1. reduced salt and caffeine intake
  2. weight reduction
  3. increase aerobic exercise
  4. reduce alcohol consumption
  5. smoking cessation
35
Q

what is the main benefits of antihypertensive therapy?

A

BP lowering

lessening risk factor for cerebral, cardiac and renal events

36
Q

what is step 3 treatment for a patient of any age with stage 2 hypertension who has not been improving with step 1 and step 2 treatment?

A

ACE/ARB + Calcium antagonist

+ thiazide diuretic

37
Q

what is the step 4 treatment for a patient of any age with stage 2 hypertension who has not been improving with step 1, step 2 and step 3 treatment?

A

ACE/ARC + calcium antagonist
+ thiazide diuretic
+ further diuretic
(or alpha/beta blocker if further diuretic not tolerated/effective)

38
Q

what further diuretic is used in step 4 resistant hypertension management if the patient has low levels of potassium?

A

low-dose spironlactone

39
Q

which is more effective in the treatment of hypertension: adding an additional drug or titrating the original drug?

A

adding a drug

Cardiovascular (12 decks)

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