Hypertension Flashcards
If the blood pressure in clinic is 140/90 or higher what is the next appropriate step?
offer ambulatory BP monitoring to confirm diagnosis HTN
if ABPM isn’t tolerated/contraindicated home blood pressure monitoring is a suitable alternative
if it is severe consider HTN meds immediately
How does ambulatory blood pressure monitoring work?
at least two measurements per hour during the person’s usual waking hours (usually 14/day).
how does home blood pressure monitoring work?
two consecutive seated measurements, 1 minute apart
BP is recorded twice a day for at least 4 days and preferably for 7 days
measurements on the first day are discarded –
average value of all remaining is used.
Define stage 1, stage 2 and stage 3 hypertension
Stage 1 hypertension:
Clinic BP is 140/90mmHg or higher and
ABPM or HBPM daytime average is 135/85mmHg or higher.
Stage 2 hypertension:
Clinic BP 160/100mmHg or higher and
ABPM or HBPM daytime average is 150/95mmHg
or higher.
`Severe hypertension:
Clinic BP is 180mmHg or higher or
Clinic diastolic BP is 110mmHg or higher.
For every patient with hypertension what 4 things need to be offered? how is cardiovascular risk estimated?
- test urine for presence of protein
- take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
- examine fundi for hypertensive retinopathy
- arrange a 12-lead ECG.
A formal estimation of cardiovascular risk must be used e.g. ASSIGN or UK JBS3 lifetime risk calculator
What 4 things may be seen in end organ damage due to hypertension?
- Left Ventricular Hypertrophy
- Creatinine Raised
- Albuminuria / microalbuminuria
- Retinopathy
For stage 1 hypertension what is the treatment?
if no target organ damage or 10-year cardiovascular risk in less than 20 then:
- offer lifestyle interventions
- patient education and interventions
- annual review of care to monitor BP/discuss lifestyle/symptoms/meds
When is a specialist referral considered for stage 1 hypertension?
if younger than 40 years
when are antihypertensive drugs offered?
- stage 2 hypertension
- target organ damage present
- 10-year cardiovascular risk >20%
Describe step 1 antihypertensive treatment:
- for those under 55
- for those over 55 or those with african/carribean family origin
Step 1 for those under 55:
ACE-inhibitor e.g. lisinopril
or (if can’t tolerate ACE-I due to e.g. dry cough or contraindicated)
ARB e.g. losartan
Step 1 for those over 55/afro-carribean:
-calcium channel blocker e.g. amlodipine
or (if CCB causes oedema or intolerane/if evidence heart failure or high risk heart failure)
-thiazide like diuretic
Describe step 2 antihypertensive treatment?
- add calcium channel blocker to ACE inhibitor or ARB unless heart failure/heart failure risk/oedema/intolerance to CCB then give thiazide-like diuretic
- if african or carribean family origin give ARB in preference to ACEI
Describe step 3 of antihypertensive treatment
add on thiazide like diuretic
what are target blood pressures for people aged under 80 and people aged 80 and over?
under 80: 140/90 clinic or 135/85 ABPM or HBPM
over 80: 150/90 or 145/85 ABPM or HBPM
What are 4 common causes for secondary hypertension?
- Renal disease (reduced renal blood flow, excess renin release, salt and water overload)
- Obstructive Sleep Apnoea
- Aldosteronism (conn’s syndrome)
- Reno-vascular Disease
What 3 lifestyle interventions should be advised to patients?
- diet: reduce sodium and caffeine intake, weight reduction and exercise
- Alcohol consumption
- smoking
