Hypertension Flashcards
What is stage one hypertension?
Clinic more than or equal to 140/90
ABPM more than or equal to 135/85
What is stage two hypertension?
Clinic more than or equal to 160/100
ABPM more than or equal to 150/95
What is severe hypertension?
Clinic more than or equal to 180 systolic
ABPM more than or equal to 110 systolic
What is the BP target of someone below 80 years?
<140/90
What is the BP target of someone above 80 years?
<150/90
What us essential hypertension?
High BP where an underlying cause cannot be identified
What is secondary hypertension?
High BP where an underlying cause is identified
e.g. renal or endocrine disease, COCs, venlafaxine, sympathomimetics and alcohol
What is white coat hypertension?
Clinic BP of 140/90 or higher but normal when assessed by ABPM
When should BP be reassessed?
BP< 140/90 reassess every 5 years
Increased frequency if BP close to 140/90 (annually)
What is the target BP for the majority of people with diabetes?
<140/80
What is the BP target for diabetics at ‘high risk’?
<130/80
What drug class is 1st line for people with T2DM and HTN?
ACE inhibitors
Unless African-Carribbean= ACEi plus CCB or diruretic
What drug classes can be particularly beneficial for people with renal failure?
ACEis and ARBs
what drugs are most commonly sued for HTN in pregnancy?
Labetalol, methyldopa, CCBS (Nifedpine)`
What is the advice on weight, dietary sodium intake and exercise for people with HTN?
BMI 20-25 kg/m2
<100mmol/day sodium (<6g salt)
30-60 mins of exercise 3-5 times a week
What are two non-dihydropyridine CCBs?
Diltiazem
Verapamil
Name 3 longer acting dihydropyridine CCBs?
Amlodipine
Felodipine
MR Nifedipine
Why are Diltiazem and Verapamil rarely used in HTN?
Due to their interactions and effect on cardiac rhythm
What are the most common adverse effects experienced with CCBS?
Oedema, headache, GI disturbances and flushing
What is a common SE of verapamil?
Constipation
What renal effect must ACEis have in order for them to be stopped?
Cr rise by more then 20%
or
eGFR falls by more than 15%
What are 3 SEs of ACEis?
Worsening renal function
Hyperkalaemia
Dry cough
Name 2 thiazide like diuretics
Chlortalidone
Indapamide
What are 6 adverse effects of thiazide diuretics?
Impaired glucose intolerance Hypokalaemia Hyponatraemia Increase in plasmid lipids Gout Impotence
When are B-blockers advised?
In younger people
People with HTN and angina
Why are B-blokers contraindicated in asthma?
risk of bonchospasm
What problems can Prazosin cause?
Postural hypotension, dizziness, vertigo
What are
a) short acting
b) Long acting
a blockers?
a) Prazosin
b) Doxazosin, Terazosin
What is spironolactone?
An aldosterone antagonist
What is a SE of spironolactone?
Hyperkalaemia
What can hydralazine cause when used alone?
Tachycardia
Fluid retension
What adverse effects does Minoxidil frequently cause?
Peripheral oedema, reflex tachycardia, hair growth
What are 3 centrally acting antihypertensives?
Clonidine
Methyldopa
Moxonidine
When should thiazides be avoided?
eGFR< 30ml/min
Each HTN QoF point is worth approx how much?
£160 to the practice
What are the monitoring requirements for ACEis/ARBs?
Baseline U+Es
BP/U+Es within 10 days and then 3 months of commencing or changing dose then annually.
If Cr increased by >20% or eGFR decreased by >15% stop ACEi, monitor and refer.
If K is more than or equal to 5.0mmol/L stop ACEi, monitor and refer
What are the monitoring requirements for diuretics?
Baseline U+Es/urinalysis
U+Es after 1 months or dose changes
U+Es annually once stable
Urinalysis annually
What must happen if ABPM is not available?
Individual must return for at least another 2 subsequent clinic visits (2 week intervals).
BP assessed from at least to readings.
If over 75- 3rd reading standing to detect postural hypotension
What is ‘optimal BP’?
<120/<80
What is ‘normal’ BP?
<130/<85
What is ‘high normal’ BP?
130-139/85-89
How often should a person with HTN be monitored?
BP/pulse- 6 monthly
Urinalysis-annually
Fasting lipids- annually
FBC- 5 yearly
Diastolic or systolic BP is more commonly raised in people younger than 50?
Diastolic
When using ABPM to confirm a HTN diagnosis, what needs to be ensured?
at least 2 measurements per hour are taken during the person’s usual waking hours
For ABPM, the average of how many readings should be used?
At least 14
What is the advice for HBPM for HTN diagnosis?
2 consecutive measurements are taken at least 1 min apart with person seated.
BP recorded twice daily.
Recording continues for at least 4 days, ideally 7.
Discard readings taken on day 1
A fall in BP by more than what when a person is standing indicates postural hypotension?
20mmHg or more
If 3 BP measurements are taken in a clinic, which one should be recorded?
The lower of the last 2 measurements
