Hypertension Flashcards
Histological heart changes
HBP widens arteries, putting a strain on the walls of the arteries.
Artery muscles thicken which restricts blood flow.
Fatty deposits build up (plaques) and restrict blood flow.
Primary (essential) hypertension
Commonest
No known cause
Pre-disposing factors: age, obesity, alcohol, genetics, salt
Secondary hypertension
Less common
Underlying cause present - hypertension is due to another disease/process
Benign hypertension
Asymptomatic - incidental finding
Cause of serious life threatening morbidity
Malignant hypertension
More common in secondary hypertension
Causes rapid development of end organ damage
Which blood pressure defines hypertension?
Clinic BP of 140/90mmHg or higher
Aim for below 140/90mmHg in people < 80
Aim for below 150/90mmHg in people > 80
Diagnosing hypertension
ABPM: at least 2 measurements per hour during normal waking hours
HBPM: 2 consecutive readings sitting down 1 minute apart, twice per day for minimum of 4 days
Stage 1 hypertension
Clinic BP 140/90mmHg or higher
ABPM/HBPM 135/85mmHg or higher
Stage 2 hypertension
Clinic BP 160/100mmHg or higher
ABPM/HBPM 150/95mmHg or higher
Severe hypertension
Clinic systolic BP 180mmHg or higher
Clinic diastolic BP 110mmHg or higher
White coat hypertension
High BP when visiting the doctor, normal BP at home
Masked hypertension
Low BP at clinic
High BP at home
Hypertension management (under 55)
Step 1: ACE inhibitor
Step 2: ACE inhibitor + CCB
Step 3: ACE inhibitor + CCB + Diuretic (thiazide-like)
Step 4: spironolactone/ alpha blocker/ beta blocker
Hypertension management (over 55 or any black person of african/Caribbean origin)
Step 1: CCB (or thiazide like diuretic)
Step 2: CCB + ACE inhibitor
Step 3: CCB + ACE inhibitor + diuretic (thiazide like)
Step 4: Spironolactone/ alpha blocker/ beta blocker
Combination therapy
It is better to use a combination of low dose drugs than one drug on its own
