Hypertension Flashcards
what is essential hypertension?
a rise in blood pressure of unknown cause that increase risk for cerebral, cardiac and renal events
what did the Framingham study assess?
the risk of coronary heart disease, stroke and heart failure in a 36 year follow up of patients aged 35-64
for individuals aged 40-69 years old, when does CV mortality risk double?
with each 20/10 mmHg
increased to blood pressure
what is hypertension?
the level of blood pressure where the treatment does more good than harm
how do you confirm the diagnosis of hypertension if the clinic BP is 140/90 mmHg or higher?
offer ambulatory blood pressure monitoring
ABPM
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?
home blood pressure monitoring (HPBM)
when would you start an anti-hypertensive drug solely on the clinic BP results, without waiting for the result of ABPM or HBPM?
if the patient has severe hypertension
(clinic SBP is 180mmHg+
or clinic DBP is 110mmHg+)
to confirm a diagnosis, what readings must you ensure the ABPM has got?
at least 2 measurements per hour during waking hours
14 days usually
to confirm a diagnosis, what readings must you ensure the HBPM has got?
2 consecutive measurements, 1 minute apart
BP recorded for at least 4 days (7 days preferred)
[measurements on the first day are discarded]
if hypertension is not diagnosed, how often do you want to measure the person’s clinic blood pressure?
at least every 5 years
even more frequently if their clinic BP is nearing 140/90mmHg
what is state 1 hypertension?
clinic BP is 140/90 mmHg or higher
AND
ABPM or HBPM daytime average is 135/85 or higher
what is state 2 hypertension?
clinic BP is 160/100 or higher
AND
ABPM is 150/95
what is severe hypertension?
clinic systolic BP is 180mmHg or higher
OR
clinic diastolic BP is 110mmHg or higher
for all patients with diagnosed hypertension what 4 extra tests should you offer during the diasnosis stage?
- 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
when measuring estimated CV risk what BP value should you use?
clinic BP
what is the % CV risk that diabetes gives?
20%+
what is the main driver of absolute CV risk?
age
what is the % CV risk that established vascular disease gives?
> 20%
what is Grade I of the KWB classification of hypertensive retinopathy?
slight or modest narrowing of the retinal arterioles with the arteriovenous ratio >_ 1:2
what is grade II of the KWB classification of hypertensive retinopathy?
modest to severe narrowing of the retinal arterioles (focal or generalised) with an arteriovenous ratio below 1:2 or with arterial nicking
what is the grade III KWB classification of hypertensive retinopathy?
bilateral soft exudates or flame-shaped haemorrhages
what is the grade IV KWB classifiaction of hypertensive retinopathy?
bilateral optic nerve oedema
if a patient over 40 has stage 1 hypertension what is the management?
[CBPM 140/90mmHg or greater AND HBMP 135/85mmHg or greater]
lifestyle interventions
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]
anti hypertensive drug treatment with ACE inhibitor
or ARB if ACE is not tolerated well
what should you never combine an ACE with to treat hypertension?
ARB
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]
anti hypertensive drug treatment with calcium antagonist
if calcium antagonisr not suitable use thiazide diuretic
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]
anti hypertensive drug treatment with calcium antagonist
if calcium antagonist not suitable use thiazide-diuretic
why might a calcium antagonist not be suitable for treatment of stage 2 hypertension in a patient over 55 or of black/caribbean origin?
oedema
heart failure
not tolerated
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]
step 2:
add on a calcium antagonist with the step 1 ACE/ARB
(if calcium antagonist not suitable use thiazide diuretic)
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]
step 2:
add on a ARB with the step 1 calcium antagonist/thiazide diuretic
what are the aims of hypertension drug treatment in a patient under 80?
CBPM 140/90 mmHg
what are the aims of hypertension drug treatment n a patient over 80?
CBPM 150/90 mmHg
what percentage of BP variability is genetically determined?
30-50%
what type of lifestyle advice do you give to a person with stage 1 hypertension?
[CPBM 140/90mmHg and APBM/HPBM average 135/85mmHg]
- reduced salt and caffeine intake
- weight reduction
- increase aerobic exercise
- reduce alcohol consumption
- smoking cessation
what is the main benefits of antihypertensive therapy?
BP lowering
lessening risk factor for cerebral, cardiac and renal events
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?
ACE/ARB + Calcium antagonist
+ thiazide diuretic
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?
ACE/ARC + calcium antagonist
+ thiazide diuretic
+ further diuretic
(or alpha/beta blocker if further diuretic not tolerated/effective)
what further diuretic is used in step 4 resistant hypertension management if the patient has low levels of potassium?
low-dose spironlactone
which is more effective in the treatment of hypertension: adding an additional drug or titrating the original drug?
adding a drug
