Hypertension Flashcards
What is primary hypertension?
No underlying cause. Strong polygenic familial trend, environmental factors. 95%
What is secondary hypertension? What might cause it? (4)
Result of underlying condition. 5%. Coarctation of the aorta, renal disease, endocrine problem, drugs.
What renal diseases may result in hypertension? (3)
Renovascular issues, glomerulonephritis, obstructive uropathy
What endocrine issues may be a cause of hypertension? (5)
Conn’s (hyperaldosteronism), Cushing’s (hypercortisolism), phaeochromocytoma, acromegaly, carcinoid
What drugs may be the cause of hypertension? (3)
Alcohol, corticosteroids, NSAIDs
What symptoms could be caused by hypertension? (6)
Usually asymptomatic. Visual disturbances, headaches, shortness of breath, chest pain, palpitations, urinary symptoms
What examinations would you do post diagnosis of hypertension? (4)
Fundoscopy, CR exam, chest exam, abdo exam
What examinations would you carry out to check for coarctation? (4)
Physical exam, chest radiograph, echocardiogram, CT/MRI of aorta
What examinations would you carry out to look for renal causes? (3)
Renal USS, CT/MRI of kidneys/ bloody supply, renal artery Doppler
How would you investigate for Conn’s?
Plasma renin activity, aldosterone
How would you investigate for Cushing’s?
Overnight dexamethasone, 24hr urine cortisol
How would you investigate for a drug related cause?
Urine, toxicology
How is hypertension diagnosed? (3)
Clinic BP >140/90. ABPM- measures over 24hrs. HBPM- 2 consecutive a day >1 min apart 2x a day for > 4 days. Avg not including first day
What is stage 1 hypertension?
BP>140/90 in clinic and ABPM/ HBPM mean >135/85
What is stage 2 hypertension?
Clinic BP >160/100. ABPM/ HBPM mean > 150/95
What is severe hypertension?
Clinic SBP>180 or DBP>110.
How would you treat stage 1 hypertension?
Offer lifestyle interventions and education unless target organ damaged (+antihypertensive) or under 40 (specialist referral)
What BP is aimed for during treatment?
Under 80 <140/90. Over 80 <150/90
When is an ACE inhibitor not frontline treatment for hypertension?
African/ Caribbean any age or over 55s . CCB first then add ACE inhibitor
What is postural hypotension?
Decrease when standing of more than 20 systolic and 10 diastolic
How would you manage postural hypotension? (4)
Less rigid control of hypertension. Elevate head of bed, use water as vasopressor. Improve venous return eg with compression stockings
What are 4 conditions in pregnancy associated with blood pressure?
Gestational hypertension- after 20 weeks. Add proteinuria = pre-eclampsia. Eclampsia- convulsive condition associated with former. Chronic hypertension if pre existing.
What are the potential consequences of not treating these conditions during pregnancy?
Increased perinatal mortality, preterm birth, low birth weight
What is the aim for hypertension in pregnancy?
<150/100 or <140/90 if organ damage
If the mother is diabetic, has CKD, hypertension, problems in previous pregnancy, what would you give her?
75mg aspirin 12 weeks to birth
What antihypertensives are contraindicated in pregnancy? (3 types)
ACE inhibitors, ARBs, chlorothiazide. They are teratogenic
