hypertension Flashcards
what is normal BP
90/60 –> 140/90
what is state 1 hypertension
clinic BP _> 140/90
+
ABPM day time average _> 135/85
what is state 2 hypertension
clinic BP _> 160/100
+
ABPM _> 150/95
what is severe hypertension
SBP > 180
DBP > 110
is an ABPM required in severe hypertension
no - start drug treatment before ABPM
what measurements should ABPM take
at least 2 measurements per waking hour for 14 days
when is HBPM used
if unable to tolerate ABPM
what measurements should HBPM take
2 consecutive measurements i minute apart for at least 4 days (7 days)
1st measurement is discarded
what is the BP aim for under 80
140/90
or
135/85 ABPM
what is the BP aim for over 80
150/90
or
145/85 ABPM
what is some life advice for hypertension
reduce salt reduce caffeine lose weight reduce alcohol stop smoking increase aerobic exercise
what is the first line treatment for hypertension in under 55s
ACEI
ARB if dry cough
if ACEI isn’t tolerated e.g. of child bearing potential what should used as treatment for hypertension in under 55s
beta blocker
what is the first line treatment for hypertension in over 55s/afro-carribean
Calcium channel blocker
what is the step 2 treatment for hypertension in under 55s
ACEI + CCB
what is the step 2 treatment for hypertension in over 55/afro-carribean
CCB + ACEI/ARB
what is the step 3 treatment for all in hypertension
+ thiazide diuretic
what is the step 4 treatment for all in hypertension
increase thiazide diuretic
possibly add alpha or beta blocker
if low potassium - low dose spironolactone
what is secondary hypertension
underlying disease
what are some examples of underlying disease in secondary hypertension
renal artery stenosis (any renal disease) - excess renin release pheochromocytoma (excess NA) obstructive sleep apnoea glomerulonephritis conns syndrome (excess aldosterone) cushings syndrome (excess cortisol) hyperparathyroidism aortic coarctation intracranial tumour
what is malignant hypertension
needs urgent treatment
what are some causes of malignant hypertension
cerebral oedema (seen as papilloedema - swelling of optic disc)
acute renal failure
acute heart failure
what is seen in malignant hypertension
blood vessels show fibrinoid necrosis and end arteritis proliferans of their walls
what is primary hypertension
no obvious cause
- genetic, salt intake, protein intake
what is essential hypertension
rise in BP of unknown cause that increases risk for cerebral, cardiac and renal events (BP > 140/90)
what is the definition of hypertension
BP where treatment does more good than harm
how do you diagnose postural hypotension
measure BP supine or seated
stand up 1 minute
measure BP again
what drug is used for hypertension with prostatic hypertrophy
alpha blocker
what drugs are good in diabetic neuropathy
ACEI/ARB
