Hypertension Flashcards
what is the definition of hypertension
> 140mmHg +/ 90mmHg on 3 separate occasions
record lowest reading
what is the definition of malignant hypertension
> 200/130mmHg
what is the aetiology of hypertension
primary -idiopathic in 90% of cases secondary -renal -endocrine -cardiovascular -drugs -pregnancy (pre-eclampsia)
what are the renal causes of HTN
renal artery stenosis chronic glomerulonephritis chronic pylonephritis polycystic kidney disease chronic renal failure
what are the endocrine causes of HTN
DM hyperthyroidism Cushings syndrome Conns syndrome hyperparathyroidism phaeochromocytoma congenital adrenal hyperplasia acromegaly
what are the cardiovascular causes of HTN
aortic coarctation
increased intravascular tone
what are the drugs which case HTN
sympathomimetics
corticosteroids
COCP
what is the epidemiology of HTN
very common
increases with age
what is the history associated with hypertension
often asymptomatic
symptoms of complication/cause
what is the history associated with malignant hypertension
scotomas (visual field loss) blurred vision headaches acute HF seizures nausea vomiting
what would be the expected examination findings in hypertension
loud 2nd HS/presence of 4th HS
radioradial delay (aortic coarctation)
radiofemoral delay (aortic dissection)
renal artery bruit (renal artery stenosis)
what is the Keith Wagner Classification of retinopathy in hypertension
I ‘silver wiring’
II plus arteriovenous nipping
III plus flame haemorrhages and cotton wool exudates
IV plus papilloedema
what is the difference between cotton wool spots (soft exudates) and flame haemorrages (hard exudates)
soft exudates-ischaemia
hard exudates-cholesterol
what is the pathology of hypertension
fibrotic intimal thickening of arteries
reduplication of elastic lamina and SM hypertrophy
arteriolar wall layers are replaced by pink hyaline material
luminal narrowing occurs
what investigations would be performed in suspected hypertension
1 BP: >140/90 2 ECG -signs of LVH, ischaemia or infarction 3 bloods -UEs, glucose -lipids (high LDL, low HDL) 3 urine dipstick -increased albumin excretion suggests end-organ damage -proteinuria 4 ambulatory BP monitoring -excludes 'white coat syndrome' -allows monitoring of treatment response
what are the signs of LV hypertrophy
deep S wave in V1-2
tall R wave in V5-6
inverted T waves in I, AVL, V5-6
LAD
what are the lifestyle changes for conservative management of hypertension
stop smoking
lose weight
reduce alcohol
reduce salt
when would investigation for secondary causes form part of the management of hypertension
in young patients
in malignant hypertension
with poor response to treatment
what are the indications for medical treatment of hypertension
> 160mmHg SBP
100mmHg DBP
evidence of end-organ damage
what are the medical treatments available for management of hypertension
1 thiazide diuretics (bendroflumethiazide)
2 ACE inhibitors (ramipril)/ Angiotensin II antagonists (losartan)
3 CCBs (amlodipine)
4 B-blockers (atenolol)
5 A-blockers (doxazosin)
what is the 1st line treatment for hypertension in <55yrs
ACE inhibitor
what medication would be given for hypertension in >55yrs/black people
CCB (amlodipine)
what medication would be given for hypertension in <55yrs/diabetics/HF/LV dysfunction
ACE inhibitors (ramipril) angiotensin II antagonist (losartan)
what medication would be given for hypertension in >60yrs+black
CCBs (amlodipine)
what two hypertensive medications should not be given together and why
thiazide diuretic and beta-blockers
to reduce risk of developing diabetes
what is another use of a-blocker (doxazosin)
in prostatism
for outlet obstruction at neck of bladder caused by benign prostatic hypertrophy
what is the target BP for patients with hypertension
<140/85mmHg in non-diabetics
<130/80mmHg in diabetics without proteinuria
<125/75mmHg in diabetics with proteinuria
what medications would be used in severe hypertension (>140mmHg DBP)
atenolol/nifedipine
what medications would be used in acute malignant HTN
IV beta blocker
why should rapid lowering of BP be avoided
can cause cerebral infarction
what complications are associated with hypertension
HF, CAD, MI cerebrovascular accident peripheral vascular disease emboli retinopathy renal failure hypertensive encephalopathy posterior reversible encephalopathy sydrome malignant HTN
what is the prognosis associated with hypertension
if uncontrolled:
6x stroke risk
3x cardiac risk
what is the criteria for controlling blood pressure in those with chronic kidney disease and DM
start medication if BP >140/90
risk factors
obesity
little or no exercise
alcohol intake
