Hypertension Flashcards
What are the criteria for diagnosis of HTN using the following:
- clinic BP
- ambulatory BP (awake)
- ambulatory BP (asleep)
- Ambulatory BP over 24 hrs
- Home blood pressure monitoring
- > 140 and or >90
- > 135 and or >85
- > 120 and or >70
- > 130 and or >80
- > 135 and or >85
What are non dippers and what is the CVD risk associated with these patients?
People who do not show a 10% dipping in nocturnal BP on Ambulatory BP measurement are called “non dippers”
Associated with increased CVD risk.
What are the grades of BP measurement?
Grade 1 (mild) Grade 2 (moderate) Grade 3 (severe)
mild: 140-159 systolic and 90-99
moderate: 160-179 systolic and 100-109 diastolic
severe: >180 systolic and >110 diastolic
What are secondary causes of hypertension?
Most common: chronic GN, pyelonephritis (from reflux), analgesic nephropathy
Renal: PCOS, renal a.stenosis, renal v. thrombosis, glomerulonephritis
Endocrine: hypothyroidism, cushing’s, hyperparathyroidism
Drugs: steroids, nsaids, etoh, ocp, lithium, natural liquorice
Coarctation of aorta
Adrenal e.g. hyper aldosteronism
Tumours: Pheochromocytoma, wilm’s tumour, neuroblastoma
Sleep Apnoea
What are some investigations with diagnosis of htn?
bloods: fbc/uec/lfts ECG: AF/LVH \+/- Echo \+/- carotid u/s Urine dipstick for proteinuria Ankle Brachial Index: if <0.9 = PVD Plasma aldosterone: renin and or metanephrine
Pt’s with CVD risk 10-15% when would you consider pharmacological therapy?
persistently >160/90
fhx of early cvd (e..g male relative <55y, female relative <65yo)
ATSI
What is a
- hypertensive urgency
- hypertensive emergency
- > 180/110 with mild headache
2. >220/140 with end organ damage (e.g. acute heart failure, oedema, AMI, ARF)
What is the approach to starting antihypertesive meds:
- start low to moderate dose,
if not optimised at 3/12 - if high add second agent
if not optimised at 3/12 - if high increase one of the drugs incrementally to max dose (except thiazide diuretics). if not optimised at 3/12
- if despite two max doses, start 3rd at low to mod dose, look for 2ndry causes of htn
- if contains of heart block,es to be elevated, then consult
Diabetes and lipid abnormalities, which combination of antihypertensives?
ACE or ARB plus calcium channel blocker
Heart failure or post stroke, which combination of antihypertensives?
ACE or ARB plus thiazide
Post MI, or in patients with heart failure, which combination of antihypertensives?
ACE or ARB plus Beta Blocker
useful in symptomatic coronary heart disease?
beta blocker and dihydropyridine calcium channel blocker
What are the combinations of antihypertensives to be careful with?
Diltizem and beta blocker (due to rik
When is it not appropriate to use the CVD calculator?
CVD. The calculator should not be used
in those that are already at increased (high) risk of cardiovascular disease.
These patient groups include those with:6
• diabetes and aged >60 years
• diabetes with microalbuminuria (>20 μg/min or UACR >2.5 mg/mmol for males and >3.5 mg/mmol for females)
• moderate or severe chronic kidney disease (persistent proteinuria or estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2)
• patients with familial hypercholesterolaemia
• systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110mmHg
• serum total cholesterol >7.5 mmol/L
- ATSI patients >74
(Ref: Cardiology Check 2016)
Which specific physical examinations would you perform for a patient with HTN?
carotid bruits
fundi
abdominal exam - AAA, renal bruits, ballot the kidneys for Polycystic Kidney Disease
(Ref: Cardiology Check 2016)
