- measure BP seated or supine - stand patient for 1 minute - systolic drops by more than 20mm

- 24 hour - take BP 3 times an hour during day - hourly at night - night should dip, if not = worse prognosis - home monitoring acceptable alternative

Hypertension Flashcards by Amrita Heer

Symptoms

End organ damage

Headaches and nose bleeds not really caused by it but common

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Stage 1 definition

140/90
AND
ABPM 135/85

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Stage 2 definition

160/100
AND
ABPM 150/95

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Stage 3 definition

Systolic >180

Diastolic >110

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Malignant hypertension

BP>180/110

Papilloedema or retinal haemorrhages

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Postural hypotension

measure BP seated or supine
stand patient for 1 minute
systolic drops by more than 20mm

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ABPM

24 hour
take BP 3 times an hour during day
hourly at night
night should dip, if not = worse prognosis
home monitoring acceptable alternative

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Who should be offered ABPM

All patients

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What to ask about in HPC?

pregnancy
the pill
BP check for work -e.g. HGV

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What to ask about in PMH?

diabetes
CVA
MI
renal disease

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What to ask about in FH?

cause and age of death
MI and CVA specifically
parents and siblings

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What to ask about in SH?

smoking
alcohol
salt
dairy
5 a day
exercise
caffeine
snoring

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What to ask about in CV systems review?

angina
claudication
exercise tolerance
erectile function

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What to ask about in systems review for women?

pregnancy plans

- contraception

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What to do on examination/

both arms
APBM before starting treatment
end organ damage signs = eyes, proteinuria
secondary causes = cushings, coarctaton, RAS

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What investigations

ABPM
Urinalysis
U&amp;E
Lipids
FUndi
ECG
Weight
Secondary care = ECHO, urinary cats, renin/aldo, renal/liver US

Artifact causes

White coat

wrong cuff size

Diagnosis of exclusion

genetic
city living
alcohol
obesity
salt
lack of exercise
OSA

2ry causes

phaeo
cushings
OSA
obesity
conns
renal disease
RAS
drugs = OC, steroids, recreational

Heart end organ damage

CCF

Brain end organ damage

CVA

Kidney end organ damage

Nephrosclerosis

Accelerates other forms of kidney disease

End organ damage e.g.

Brain
Heart
Kidney
Legs
ED
(depends on ethnicity)

Stage 1 management

asses CV risk
if target organ damage or 20% risk = drugs
lifestyle

Stage 2 management

- APBM check | - drugs and lifetsyle

Stage 3 management

treat now

DRUGS

- ACEi/ARB - CCB - diuretics

CI for ACEi/ARB

- check pregnancy plans - under 55 - not as monotherapy in africans or caribbean

CI for CCB

- over 55 - African or caribbeans - caution if worried about HF or oedema

Targets

- under 80 = 140/90 - over 80 = 150/90 - end organ damage, diabetic, renal disease = 130/80

Other drugs

- spironolactone - beta blockers - alpha blockers - moxonidine (centrally acts) - renin inhibitors

Which drugs to use in pregnancy

- labetolol - methyldopa - nifedipine

Surgical treatments

- renal denervation | - AV fistula