Hypertension Flashcards
Define hypertension
Impossible to define
We choose to select a value of which risk is significantly increased.
Treat all with BP >160/100 and with pts of 140/90 decision depends on risk of CVS disease
A thing to think about when patient might have HTN
do they have diabetes with it?
Hypertension is a major risk factor for ?
Stroke and MI
What is the mos common form of hypertension in the UK
Isolated systolic hypertension
What is isolated systolic hypertension
Affects >50% of 60yrs old. results in stiffeneing of large arteries (arteriosclerosis).
risk of MI is doubled and CVA tripled
treatment is very effective and reduces this excess risk
Tell me about malignant or accelerated phase hypertension
It is the rapid elevation of BP with rapid organ damage and end organ damage.
usually there is severe HTN >200/130 and bilateral retinopahty with hemorrhage and +/- papilloedema
it precipitates renal damage, heart failure or encephalopathy
untreated 90% die within 1yr 70% survival of 5yr after treatment
presents as fits, headache, visual disturbances
What is essential HTN
It is the primary HTN of unkown cause and is 95% of cases
Secondary HTN
5% of cases renal disase is the most common secondary cause (75% for intrinsic renal)
Endocrine - cushing’s, conns, hypeparathyroidism
others - coartication, pregnancy, steroids, the pill
Signs and symptoms of HTN
Usually asymptomatic
Headaches are no more common than general population
always perform for CVS exam, peripheral vascular, look for other causes
Investigations for HTN
For risk assessment - fasting blood glucose, cholestrol
Look for end organ damage - ECG, urinalysis (blood, protein)
exclude secondary causes - renal USS, urinary cortisol,
24hr ambulatory BP monitoring
Echocardiography may be useful is assessing LV hypertrophy
Grading hypertensive retinopathy
I silver or copper wiring
II A-V nipping (narrowing where A cross V)
III haemorhage and cotton wool spots
IV papilloedema
Drug management of HTN
Step1
If >55 or black give CCB
If <55 give ACE-i or ARB if ACE cough
Step 2
ACE or ARB + CCB
Step3
ACE or ARB + CCB and add thiazide
Step4
If still resistant consider adding spironalactone or increase thiazide dose. Monitor potasium and sodium levels after 1 month and repeat. –> thiazide hypoNa/HypoK, spiro hyperK
Conservative management of HTN
stop smoking
improve diet - reduce alcohol and salt
reduce weight
exercise
What is the treatment goal in HTN
aim for BP of <140/90
<130/80 in diabetes
<150/90 if >80yrs
Aim to reduce BP slowly not rapidly
Treating malignant HTN
Generally treat orally
aim to reduce BP in days not hours
