Hypertension Flashcards
true/false - automatic BP machines still work if pulse is irregular
false - do a manual pressure
in what environment would you ideally do a BP reading?
quiet, relaxed environment with patient seated
Is a clinic BP good enough to diagnose hypertension?
no, you have to take a ABPM or HBPM
what is ABPM
Ambulatory blood pressure measuring
2 readings per hour for a patients waking day
what is HBPM
Home blood pressure measuring
3 readings twice a day for 7 days
Lowest value taken
what is white coat hypertension
high blood pressure in clinic that is not normally high
what is masked hypertension
low blood pressure in clinic that is normally high
What is stage I hypertension
clinic BP - 140/90 mmHg
ABPM/HBPM - 135/85 mmHg
what is stage II hypertension
clinic BP - 160/100 mmHg
ABPM/HBPM - 150/95 mmHg
what is severe high blood pressure
clinic BP - 180/110 mmHg
Does everyone with hypertension get treatment?
no, only those with stage II or stage I with suspected organ failure or CVD risk factor >20%
in addition to testing for CVD risk, what other tests would you do?
Fundoscopy 12-lead ECG urinalysis for protein glucose fasting creatinine/albumin U+E cholesterol and TAG
end organ damage signs and types
LVH - ST depression and raised QRS
Albuminuria - renal failure
hypertensive retinopathy
raised creatinine
what causes hypertension
secondary causes
genes
environment
a -5 mmHg diastolic pressure causes…
decrease in stroke by 40% and CHD risk by 25%
Causes of secondary hypertension
OSA renal disease renovascular disease fibromuscular dysplasia cushing's phenochromocytoma hyperparathyroidism aortic coarctation intracranial tumour Conn's syndrome
ways to non-pharmacologically reduce CV risk
Reduce alcohol consumption smoking cessation lose weight if obese reduce salt intake DASH diet
how many people have a salt sensitivity relating to BP?
25%
If a high risk normotensive with normal cholesterol was in your practice, would you prescribe a statin to lower both?
yes!
first line antihypertensive for under 55
ACEI or ARB or BB for pregnant/fertile women
first line antihypertensive for over 55/black patient any age
CCB or diuretic
second line antihypertensives if response nil
ACEI/ARB and CCB OR ACEI/ARB and diuretic
third line antihypertensives if response nil
ACEI/ARB, CCB and diuretic
antihypertensives if all other lines fails
alpha/beta blocker
Spironolactone if resistant - low slow dose
what are the drug treatment targets for hypertension
<65 - 140/90, 130/80 if tolerated
>65/diabetic - 130-140/90 but not under 120 mmHg
very old - 130-140 but not under 130 mmHg
is upping a dose or adding a drug better?
adding a drug
how do NSAIDS cause increase in BP
salt retention
true/false - systolic BP increases with age
true
true/false - diastolic BP increases with age
false - it increases with age and then decreases
what happens if HTN is untreated?
it becomes resistant due to vascular and renal damage
hypothyroidism is directly linked to high BP
not really, it causes dyslipidaemia due to high triglycerides so increases CV risk
what would a renal ultrasound/MRA/TTE reveal and who would it be done in?
fibromuscular dysplasia
9 times more common in women
why do older people have a higher therapeutic target for BP
pulse pressure widens with age as diastolic pressure drops
if BP lowered too much coronary arteries will not be effectively perfused
if an expecting mother has a high BP would you aggressively lower it?
no, it can be adverse on foetus
can you give ARB/ACEI in breastfeeding
no, its not been tested to be safe yet
where is pre-eclampsia most common following a mother with a previous Hx pre-eclampsia
HELLP
why do you treat high hypertriglyceridaemia
to prevent acute pancreatitis
if you put a patient on an ACEI, ARB or spironolactone what MUST you tell them
not to take it if you have had diarrhoea, vomiting or dehydration
Renal function must be annually monitored
Watch out for dry cough
conns syndrome causes excess ____
aldosterone
cushings syndrome causes excess ___
corticosteroid
phaeochromocytoma causes excess ___
noradrenaline
how does renal failure or stenosis cause hypertension
less blood flow to kidneys so increased renin release to increase fluid retention
effect of hypertension on eyes
can cause hypertensive retinopathy
may lead to papillary oedema
effect of hypertension on brain
can cause stroke or TIA
headache due to raised ICP
subarachnoid harmorrhage due to ruptured berry aneurism
effect of hypertension on heart
causes LVH leading to ischaemia due to muslce hypertrophy with no increased blood flow
causes left heart failure sometimes causing right heart and overall congestive heart failure
effect of hypertension on kidneys
high pressure may cause kidney failure/disease
malignant hypertension has diastolic pressure >…
130-140 mmHg
malignant hypertension may cause
cerebral haemorrhage
fibrinoid necrosis in blood vessels
acute renal and heart failure
papillary oedema in retina
effect of hypertension on blood vessel
plasma proteins forced into vessel wall to cause hyaline atherosclerosis
hypertrophy T media
