Hypertension Flashcards
Hypertension definition
The blood pressure above which the benefits of treatment outweigh the risks in terms of morbidity and mortality
usually: >140/>90
Causes of hypertension
RENAL DISEASE:
Chronic renal disease, Renal artery stenosis, fibromuscular dysplasia, polycystic kidneys
DRUG INDUCED:
NSAIDs, OCP, corticosteroids, cocaine
PREGNANCY:
pre-eclampsia
ENDOCRINE:
Conn’s syndrome, Cushing’s disease, hypo/hyperthyroidism, acromegaly
VASCULAR:
coarctation of the aorta
SLEEP APNOEA
- 90 - 95% of cases = primary hypertension
- no cause can be found
Factors increasing the risk of morbidity from hypertension
Smoking, Diabetes mellitus, Renal disease, Male, Hyperlipidaemia, Previous MI or stroke, Left ventricular hypertrophy
Possible hereditary causes of hypertension
Hereditary defect of smooth muscle lining arterioles = ^reactivity of resistance vessels = ^TPR
Sodium homeostatic effect - kidneys are unable to excrete appropriate amounts of sodium for a given BP. sodium and therefore fluid are retained.
hypertension risk factors
Age, Environment (mental and physical stress), Weight, Birth weight, Diet, Alcohol intake, Sodium intake, Race
End-organ damage
Damage in major organs fed by the circulatory system due to hypertension
e.g. brain, eye, blood vessels, kidney, heart
Outcomes of untreated hypertension
end-organ damage
BRAIN: stroke
EYE: retinopathy
BLOOD VESSELS: peripheral vascular disease
KIDNEY: renal disease
HEART: left ventricular hypertrophy, congestive heart failure, coronary heart disease, myocardial infarction
EWPHE and SHEP
Studies that found that treating both diastolic and systolic hypertension in the elderly significantly reduces stroke and MI
The Stepped Approach to treatment of hypertension
Uses low doses of several drugs,
A new medication is added to current therapy until target BP is achieved.
This minimises adverse effects and maximises patient compliance
BHS target Blood Pressure
<80yrs, ABPM = <130/85 mmHg
> 80yrs, ABPM = <145/85 mmHg
Stage 1 Hypertension
<80yrs,
ABPM >135/85
One/ more of the following:
- Target organ damage,
- CV disease,
- Renal disease,
- Diabetes,
- 10yr CV risk equivalent to 20% or greater.
Stage 2 Hypertension
ABPM >150/90 mmHg
Criteria for anti-hypertensive drug therapy
Stage 1 or 2 hypertension
Step 1 Treatment
<55 (not women of child-bearing age):
ACE inhibitor OR Angiotensin II receptor blocker (ARB)
> 55/ Afro-Caribbean:
Calcium-channel blocker
Step 2 Treatment
Add thiazide-like diuretic
