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4th Year CCC > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What BP generally=HTN?

A

140/90 (either or both)

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2
Q

How do you diagnose HTN

A

Take BP in both arms

If >20mmHg different, repeat

If >140/90 do again later in consultation (keep repeating until it settles)

If still >140/90 suspect HTN

Consider:

a) white coat effect
b) ambulatory bpm
c) home bpm

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3
Q

What does ABPM do?

A

Average of 14

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4
Q

What does HBPM do?

A

2x per day for 4-7 days, discard day 1

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5
Q

What are the four stages of HTN?

A

Stage 1

Stage 2

Severe

Accelerated

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6
Q

What are the BP thresholds for stage 1 htn?

A

Clinic >140/90

Home >135/85

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7
Q

What are the BP thresholds for stage 2 htn?

A

clinic >160/100

Home >150/95

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8
Q

What are the BP thresholds for severe HTN?

A

> 180 systolic or >110 diastolic

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9
Q

BP thresholds for accelerated HTN?

A

> 180/110

and

Papilloedema or retinal haemorrhage

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10
Q

What is BP target for a generally healthy person under 80yo?

A

<140/90

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11
Q

What is BP target for a diabetic?

A

<140/80

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12
Q

What is BP target for someone over 80yo?

A

<150/90

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13
Q

What is BP target or someone with diabetes and end organ damage?

A

<130/80

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14
Q

How should you investigate confirmed HTN?

A

Assess cardiac risk- 1. cholesterol (serum total and HDL), 2. Qrisk2

Fundoscopy

Lifestyle advice- diet, exercise, caffeine, stress, smoking, alcohol

Investigate organ damage (adrenal, CKD, diabetes)- 1. 12 lead ECG, 2. Urine dip (haematuria), 3. Bloods (creatinine, U&Es, glucose, eGFR, albumin and creatinine)

?Referral if: 1. accelerated HTN, 2. ?pheochromocytoma (headache, postural HTN, palpitations, diaphoresis, pallor), 3. Organ damage, 4. <40yo

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15
Q

Who should get antihypertensives? Otherwise what treatment?

A

Stage 1 and <80yo and organ damage/cardio disease/renal disease/diabetes/Q risk >20%

Stage 2 or higher, any age

Otherwise lifestyle

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16
Q

what is diet advice to give?

A

SALT: Adults should have no more than six grams of
salt a day – that’s about one teaspoon. Not adding it at the table, and ready meals and takeaways have a lot.
As a guideline, less than 0.3g salt (or 0.1g
sodium) per 100g of food is ‘a little’ and over 1.5g
salt (or 0.6g sodium) per 100g is ‘a lot’.

ALCOHOL: alcohol should be limited to no more than 14 units per week for men and women. Don’t save up your units, its best to spread evenly
across the week. A good way to reduce alcohol intake is to have several alcohol-free days a week.

WEIGHT LOSS particularly central- slow and steady weight loss, even a little helps. 0.5-1kg/week. Calorie restriction and exercise.

CAFFEINE: try and cut down if drink a lot of tea/coffee/cola/energy drinks

Whole grain carbs

5 a day

1 portion oily fish per week (salmon, pilchards, sardines, mackerel, herring and trout)- omega 3 shown to improve BP.

‘The British dieticians association has a good leaflet on diet and blood pressure’

17
Q

What is exercise advice?

A

Being physically active is one of the most important things you can do to reduce your BP.

Aim for at least 150 minutes (2 ½ hours) of moderate intensity activity a week, in bouts of 10 minutes or more. e.g. 3 x 10min brisk walks for 5 days per week (Active 10 app).

‘Moderate intensity’ means any activity that makes
you feel warmer, breathe harder and makes your heart
beat faster than usual. Remember to check first with
your doctor if you have heart problems or are new to
exercise

18
Q

What is step one of antihypertensive treatment?

A

<55y- ACEi (2nd line ARB)

> 55y OR black afro-caribbean- CCB (2nd line TLD)

19
Q

Step two of antihypertensive rx

A

ACEi/ARB + CCB (or TLD)

Afrocaribbean pref ARB to ACEi

20
Q

Step 3 antihypertensives

A

ACEi/ARB + CCB + TLD

Check compliance

21
Q

Step 4 antihypertensives

A

Consider secondary care advice

  • Spironolactone
  • Increase dose thiazide
  • alpha/beta blocker if diuretic not suitable (e.g. doxazosin)
22
Q

How should starting antihypertensives be monitored?

A

Check renal function at 2 weeks

Appointment and BP check at 4 weeks

If lifestyle only, 3-4 months)

+ annual review

23
Q

Once BP is well controlled, how often should patients be seen?

A

Annual review

24
Q

what do you need to consider with HTN in women?

A

UKMEC contraception guidance as oestrogen+BP effect

25
Q

What do ACEis drug names end in?

A

pril

26
Q

What do ARB drug names end in?

A

sartan

27
Q

What do CCB drug names end in?

A

-dipine

28
Q

Name some TLDs

A

Indapamide or chlorthalidone

29
Q

ACEi SEs

A

Dry cough, hypotension (1st dose at night), angioedema

30
Q

CCB SE

A

Ankle swelling

31
Q

How would you explain an antihypertensive?

A

Makes your blood vessels relax by blocking an enzyme

32
Q

Can you get impotence with antihypertensives?

A

Less common in ACEi than beta blocker

4th Year CCC (19 decks)

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