Hypertension Flashcards
What is hypertension(HTN)?
This is when there is elevated blood pressure due to increased peripheral vascular resistance when the cardiac output is normal.
Most patients are asymptommatic
What is essential HTN?
This is defined as a BP >140/90 mmHg with no secondary cause identified.
How is essential HTN diagnosed?
Typically screening an asymptomatic individual.
Why is treating HTN important?
This reduces the risk of mortality and of cardiac, renal and cardiovascular complications.
What is secondary HTN?
In a minority of cases, an underlying often reversible cause can be found.
This may be suspected in a younger patient < 40, resistance to HTN treatment.
Aetiology of HTN
Primary HTN has a multifactorial and heterogeneous aetiology.
This includes disturbance of auto-regulation and excess sodium intake, renal sodium retention, insulin resistance, increased sympathetic drive and dysregulation of renin system.
Causes of secondary HTN
-Vascular: Renal artery stenosis Coarctation of aorta Pre-eclampsia -Renal: Chronic kidney disease Nephrotic syndrome Glomerulonephritis Obstructive uropathy -Endocrine: Phaeochromocytoma Hyperaldosteronism Cushing's syndrome Hyper/hypothyroidism Hyperparathyroidism -Sleep apnoea -Toxic causes: Chronic alcohol excess Illicit drug use -Medications: Use of oral contraceptives Steroids, ciclosporin and atypical antipsychotics
Risk factors for HTN
Obesity High alcohol intake Metabolic syndrome T1/T2 DM Black Age > 60 FHx of HTN Sleep apnoea
Initial diagnosis of HTN
When considering a diagnosis of hypertension, measure blood pressure in both arms:
If the difference in readings between arms is more than 15 mmHg, repeat the measurements.
If the difference in readings between arms remains more than 15 mmHg on the second measurement, measure subsequent blood pressures in the arm with the higher reading.
If blood pressure measured in the clinic is 140/90 mmHg or higher:
Take a second measurement during the consultation.
If the second measurement is substantially different from the first, take a third measurement.
Record the lower of the last two measurements as the clinic blood pressure.
Confirming the diagnosis of HTN
If the clinic blood pressure is 140/90 mmHg or higher, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension.
If a person is unable to tolerate ABPM, home blood pressure monitoring (HBPM) is a suitable alternative to confirm the diagnosis of hypertension.
What should you do when using ABPM to confirm the diagnosis of HTN?
When using ABPM to confirm a diagnosis of hypertension, ensure that at least two measurements per hour are taken during the person’s usual waking hours (for example, between 08:00 and 22:00).
Use the average value of at least 14 measurements taken during the person’s usual waking hours to confirm a diagnosis of hypertension.
What should you do when using HBPM to confirm the diagnosis of HTN?
When using HBPM to confirm a diagnosis of hypertension, ensure that:
for each blood pressure recording, two consecutive measurements are taken, at least 1 minute apart and with the person seated and
blood pressure is recorded twice daily, ideally in the morning and evening and
blood pressure recording continues for at least 4 days, ideally for 7 days.
Discard the measurements taken on the first day and use the average value of all the remaining measurements to confirm a diagnosis of hypertension.
Which investigations should you do while waiting to confirm the diagnosis of HTN?
Carry out investigations for target organ damage and a formal assessment of cardiovascular risk.
This includes:
Bloods
Urine
ECG
CXR
-The results are used to calculate the QRISK3 score
What is the QRISK3 score?
The QRISK3 algorithm calculates a person’s risk of developing a heart attack or stroke over the next 10 years.
It presents the average risk of people with the same risk factors as those entered for that person.
What is the difference between QRISK®3 and QRISK®2?
QRISK3 includes more factors than QRISK2 to help enable doctors to identify those at most risk of heart disease and stroke.
These are:
Chronic kidney disease, which now includes stage 3 CKD
Migraine
Corticosteroids
Systemic lupus erythematosus (SLE)
Atypical antipsychotics
Severe mental illness
Erectile dysfunction
A measure of systolic blood pressure variability
What is a white coat HTN?
Elevated blood pressure in the healthcare setting
What are the stages of HTN?
Stage 1 (mild) Stage 2 (moderate) Stage 3 (severe)
Stage 1 HTN
Clinic BP >140/90 mmHg and daytime ABPM or HBPM >135/85 mmHg so the systolic pressure is between 140-159 and diastolic pressure is between 90-99.
Stage 2 HTN
Clinic BP >160/100 mmHg and daytime ABPM or HBPM >150/95 mmHg so the systolic pressure is between 160-179 and diastolic pressure is between 100-109.
Stage 3 HTN
Clinic BP >180mmHg and/or diastolic >110 mmHg§
What is isolated systolic HTN?
Systolic pressure >140 mmHg and diastolic pressure < 90mm Hg
Why is staging of HTN important?
Risk stratification of the patient.
Guidance of management plan.
