hypertension Flashcards
what is stage 1 hypertension?
Clinic blood pressure (BP) is 140/90 mmHg or higher
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ambulatory BP monitoring (ABPM,) daytime average or home BP monitoring (HBPM), average BP is 135/85 mmHg or higher.
what is stage 2 hypertension?
Clinic BP is 160/100 mmHg or higher
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ABPM daytime average or HBPM average BP is 150/95 mmHg or higher.
what is severe hypertension?
Clinic systolic BP is 180 mmHg or higher or clinic diastolic BP is 110 mmHg or higher.
what symptoms may a hypertensive patient experience?
- nil or headache
- sweating, headache, palpitations and anxiety
- muscle weakness or tetany may point to hyperaldosteronism
what do you look for on physical assessment of hypertension?
any secondary causes
e. g
- cushings
- enlarged kidneys (PCK)
- renal bruits
- radio-femoral delay (coarction)
what investigations are done for hypertension?
- test for protein in urine for estimation of albumin:creatinine ratio and test for haematuria
- blood sample for plasma glucose, electrolytes, creatinine, eGFR, serum cholesterol and HDL
- bloods may suggest secondary cause e.g low K, high Na, hyperaldosteronism
- 12 lead ECG
- echo if suggestion of LVH, valve disease or LVSD or diastolic dysfunction.
what are the non pharmacological treatments of hypertension?
- weight reduction if BMI is over 25kg/m2
- moderate salt and alchol
- aerobic exercise
- smoking cessation
what is the pharmacological treatment of hypertension in those under 55?
step 1) ACE inhibitor or ARB
Step 2) ACE inhibitor/ARB and CCB
step 3) ACE inhibitor/ARB and CCB and thiazide diuretic
step 4) if resistant hypertension, use above with a further diuretic or alpha or beta blocker
what is the pharmacological treatment of hypertension in those over 55 or those of African or Caribbean decent of any age?
step 1) CCB
Step 2) ACE inhibitor/ARB and CCB
step 3) ACE inhibitor/ARB and CCB and thiazide diuretic
step 4) if resistant hypertension, use above with a further diuretic or alpha or beta blocker
what is a hypertensive crisis?
increase in blood pressure, which if sustained over the next few hours, will lead to irreversible end-organ damage (encephalopathy, LV failure, aortic dissection, unstable angina, renal failure)
how is a hypertensive crisis treated?
- sodium nitroprusside
- labetalol
- GTN
- Esmolol (Acts within 60 seconds, with a duration of action of 10-20mins)
what is a hypertensive urgency?
severe blood pressure elevation that will cause damage within days
retinal changes will be apparent
diastolic is above 130mmhg
aim is to reduce BP gradually to diastolic of 100mmHg over 48-72hrs.
how is a hypertensive urgency treated?
- amlodipine
- diltiazem
- lisonopril
- ACE inhibitors
- Ca antagonists
lots of people say the most effective regimen is
- nifedipine
- amlodipine
for 3 days, continuing with amlodipine after.
what is phaechromocytoma?
triad of symptoms
- sweating
- episodic headaches
- tachycardia
although most patients will not have all three
sustained or paroxysmal hypertension is the most common sign
how is pheochromocytoma diagnosed?
measurements of urinary and plasma fractionated metanephrines and catecholamines.
24 hr urine collection is the main test. CT/MRI of pelvis and abdomen can be done for adrenal tumours.
