Hypertension Flashcards
What is HTN a risk factor for?
Chronic Kidney Disease Stoke Heart Failure Ischaemic Heart Disease (MI) Vascular Damage Cognitive Decline Premature Death
How much does risk increase with blood pressure?
For every 2mm of increase in BP, risk of IHD increases by 7% and risk of stroke increases by 10%
How much do HTN cost the UK in drugs?
1 billion pounds
What should you tell patients who have to monitor their blood pressure at home with HBPM?
- Get comfy and sit for 5 minutes
- Place cuff on upper arm skin
- Rest arm on surface level with heart
- Sit still and don’t talk during the reading
- Use same arm each time / note which arm
- Keep written record
- Don’t change your treatment without talking to the doctor
- Take 2-3 measurements with 1min gap between and record all of them
- Do this in the morning BEFORE meds and in the evening
- If BP changes by more than 10mmHg between readings, next time wait more than 5mins before starting.
- Overall 15mins.
- Record BP for 7 days
When would you send someone home with A/HBPM?
- clinic BP of +140/90
- unusual BP variability
- pregnancy
- whitecoat syndrome
- nocturnal HTN
- drug efficacy
- drug-resistant HTN
- symptomatic HypoTN
What should you tell patients who are being send home with ABPM?
- Wear the cuff under your clothes
- Attach the monitor to a waistband etc or under the pillow at night
- Will record every 15/20mins during the day and 30/60mins at night
- Machine might repeat a measurement
- Try to let your arm hang motionless is possible
- Can take it off for showers etc
How would you take a BP reading in pregnant women?
Use specific monitor approved for pregnancy as normal monitors can underestimate BP. Go manual!
Have patients lying on their RHS if in 2/3 trimester as supine is not a good position.
If diaBP is heading towards 0, can measure and record Korotkov sound 4 and 5
What are Korotkov sounds?
Phases of BP 1 - first appearance of sound that increases in volume over 2 consecutive beats = sysBP 2 - sounds may then go faint 3 - sounds can get very crisp and loud 4 - distinct sudden muffling of sounds 5 - sounds stop = diaBP
When would HTN be drug-resistant?
If it has been untreated due to a slow progressive unsymptomatic rise leading to vascular and kidney damage to the extent that it is non-treatable
How many adults have HTN, and which kind?
More than 25% and over 50% of those over 60.
Under 50 years, DBP is more commonly high
Over 50 years, SBP is more commonly the problem.
How would you diagnose HTN?
APBM: Use the average value of at least 14 measurements taken during the person’s usual waking hours. If +140/90 then diagnose.
HBPM: Discard the first day’s measurements then take an average of the remaining measurement to confirm diagnosis
What do you have to do before stating that clinic BP is +140/90?
Check both arms, if one arm is +20mmHg more than the other in SBP, redo both arms. If this change is consistent then use the arm that gives the higher reading.
Take a least 2 measurements and if the 2nd is substantially different, take a third.
Record the lower of the last two measurements as the clinic BP.
When would you give HBPM instead of APBM?
If the person cannot tolerate ABPM
What are the stages of HTN?
Grade 1 (mild) : 140-159 & 90-99 Grade 2 (moderate) : 160-179 & 100-109 Grade 3 (severe) : >180 & >110 Isolated SHTN : >140 & <90
What is a hypertensive crisis?
This is when BP rises quickly and severely. There are two types, HT urgency and HT emergency.
