Hypertension Flashcards
What BP generally=HTN?
140/90 (either or both)
How do you diagnose HTN
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
What does ABPM do?
Average of 14
What does HBPM do?
2x per day for 4-7 days, discard day 1
What are the four stages of HTN?
Stage 1
Stage 2
Severe
Accelerated
What are the BP thresholds for stage 1 htn?
Clinic >140/90
Home >135/85
What are the BP thresholds for stage 2 htn?
clinic >160/100
Home >150/95
What are the BP thresholds for severe HTN?
> 180 systolic or >110 diastolic
BP thresholds for accelerated HTN?
> 180/110
and
Papilloedema or retinal haemorrhage
What is BP target for a generally healthy person under 80yo?
<140/90
What is BP target for a diabetic?
<140/80
What is BP target for someone over 80yo?
<150/90
What is BP target or someone with diabetes and end organ damage?
<130/80
How should you investigate confirmed HTN?
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
Who should get antihypertensives? Otherwise what treatment?
Stage 1 and <80yo and organ damage/cardio disease/renal disease/diabetes/Q risk >20%
Stage 2 or higher, any age
Otherwise lifestyle
what is diet advice to give?
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’
What is exercise advice?
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
What is step one of antihypertensive treatment?
<55y- ACEi (2nd line ARB)
> 55y OR black afro-caribbean- CCB (2nd line TLD)
Step two of antihypertensive rx
ACEi/ARB + CCB (or TLD)
Afrocaribbean pref ARB to ACEi
Step 3 antihypertensives
ACEi/ARB + CCB + TLD
Check compliance
Step 4 antihypertensives
Consider secondary care advice
- Spironolactone
- Increase dose thiazide
- alpha/beta blocker if diuretic not suitable (e.g. doxazosin)
How should starting antihypertensives be monitored?
Check renal function at 2 weeks
Appointment and BP check at 4 weeks
If lifestyle only, 3-4 months)
+ annual review
Once BP is well controlled, how often should patients be seen?
Annual review
what do you need to consider with HTN in women?
UKMEC contraception guidance as oestrogen+BP effect
What do ACEis drug names end in?
pril
What do ARB drug names end in?
sartan
What do CCB drug names end in?
-dipine
Name some TLDs
Indapamide or chlorthalidone
ACEi SEs
Dry cough, hypotension (1st dose at night), angioedema
CCB SE
Ankle swelling
How would you explain an antihypertensive?
Makes your blood vessels relax by blocking an enzyme
Can you get impotence with antihypertensives?
Less common in ACEi than beta blocker
