Hypertension Flashcards
What is considered optimal blood pressure?
<120/75mmHg
What is considered normal blood pressure?
120-129/75-84mmHg
What is considered high normal blood pressure?
130-139/85-89mmHg
What is considered mildly high blood pressure?
140-159/90-99mmHg
What is considered moderately high blood pressure?
160-179/100-109mmHg
What is considered severely high blood pressure?
> 180/110mmHg
What is the definition of hypertension?
BP of >140/90 without an identifiable cause
What are the possible causes of hypertension?
Disturbance of auto-regulation Excess sodium intake Renal sodium retention Dysregulation of RAAS with high Renin activity in plasma Increased sympathetic drive Increased peripheral resistance Endothelial dysfunction Cell membrean transporter perturbations Insulin resistance/hyperinsulinaemia
What is involved in the pathophysiology of hypertension?
Structural changes, remodelling and hypertrophy in resistance arterioles
Small vessel atherosclerosis
What are the recommended lifestyle modifications in hypertension?
Dietary
Smoking cessation
Increased activity
Reduced alcohol
When should people be screened for hypertension?
Every 2 years
If high normal BP then every year
What are the common diagnostic factors in hypertension?
Presence of risk factors
BP >140/90
Retinopathy
What are the uncommon diagnostic factors in hypertension?
Headache Visual changes Dyspnoea Chest pain Sensory/motor deficit
What are the strong risk factors for hypertension?
Obesity <3days/week aerobic exercise Mod-high alcohol intake Metabolic syndrome DM Black Age >60 FH HTN/CAD Sleep apnoea
What are the weak risk factors for hypertension?
Sodium intake >2.4g/day
Low fruit and veg intake
Dyslipidaemia
What are the investigations recommended for hypertension?
ECG
Fasting metabolic panel with eGFR
Fasting lipid panel
Urinalysis
What other investigations may be considered in hypertension?
Hb Plasma renin Plasma aldosterone Renal duplex USS 24-h urine phaeochromocytoma screen 24-h urine free cortisol TSH Sleep study
What is the DDx of hypertension?
Drug-induced CKD Aortic coartation Renal artery stenosis Obstructive sleep apnoea Hyperaldosteronism Hypothyroidism Hyperthyroidism Hyperparathyroidism Cushings syndrome Phaeochromocytoma Acromegaly Collagen vascular disease Gestatonal HTN
3 main objectives in the diagnostic approach to hypertension are?
Assess risk factors
Reveal identifiable causes
Detect target-organ damage incl CVD
What things should be examined when assessing a patient with new hypertension?
BP Optic fundi BMI Carotid, abdo, femoral bruits Palpation of thyroid Examination of heart and lungs Abdo exam Palpation of lower extremities for oedema and pulses Neuro assessment
What features on examination would indicate evidence of end-organ damage from hypertension?
Retinopathy Vascular bruits Signs of CHF Evidence of AA LVH Absence of femoral pulses Abdominal bruits Secondary HTN
If a patient is white/Asian and <55 what is the 1st line treatment for hypertension?
ACEI/ARB
If a patient is black or >55 what is the 1st line treatment for hypertension?
CCB or thiazide diuretic
What is second line therapy in hypertension?
ACEI/ARB + CCB or ACEI/ARB + thiazide diuretic
What is 3rd line therapy in hypertension?
ACEI/ARB + CCB + diuretic
What is 4th line therapy in hypertension?
ACEI/ARB + CCB + thiazide diuretic PLUS - further diuretic - alpha-blocker - beta-blocker
What is 1st line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99)
Beta Blocker
+ lifestyle modification
What is 2nd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99)
CCB
What is 1st line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)
Beta blocker + CCB
What is 2nd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)
beta blocker + ACEI/ARB
What is 3rd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)
Beta blocker + thiazide diuretic
OR
ACEI/ARB + thiazide diuretic
What is 1st line therapy in an individual with hypertension, with concomitant CHF with ejection fraction <40%?
ACEI/ARB + beta-blocker PLUS - diuretic - aldosterone agonists - isosorbide dinitrate/hydralazine
What is 1st line therapy in an individual with hypertension, with concomitant LVH without CAD?
ARB/ACEI
What is 1st line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN?
ACEI/ARB
What is 2nd line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN?
CCB
OR
Thiazide diuretic
What is 1st line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN not at goal with monotherapy or stage 2 HTN?
ACEI/ARB + thiazide diuretic
What is 2nd line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN not at goal with monotherapy or stage 2 HTN?
ACEI/ARB + CCB
What is 1st line therapy in an individual with hypertension, with concomitant AF without other comorbidity?
Beta blocker
What is 2nd line therapy in an individual with hypertension, with concomitant AF without other comorbidity?
CCB
What is 1st line therapy in an individual with hypertension, with refractory/resistant hypertension at any stage, without CHF?
Individualised therapy
What is 1st line therapy for a pregnant woman <37 weeks gestation with mild-mod hypertension?
Lifestyle modification
Delivery if increased risk
What is 2nd line therapy for a pregnant woman <37 weeks gestation with mild-mod hypertension?
Antihypertensives (methyldopa/labetalol/nifedipine)
Delivery if increased risk
What is 1st line therapy for a pregnant woman <37 weeks gestation with severe hypertension?
Antihypertensives (methyldopa/labetalol/nifedipine)
What is 1st line therapy for a pregnant woman >37 weeks gestation with mild-mod hypertension?
Induction of labour/delivery
What is 1st line therapy for a pregnant woman >37 weeks gestation with severe hypertension?
Antihypertensives (methyldopa/labetalol/nifedipine)
+
Induction of labour/delivery