Hypertension Flashcards
What is essential HTN?
Idiopathic HTN - no known cause
Causes:
Kidney diseases:
- CKD would cause HTN. What would cause reduced perfusion to the kidneys leading to lowered GFR?
Endocrine:
- How does Cushing’s cause HTN?
- An endocrine disorder can lead to hyperaldosteronism. What is this syndrome called?
Renal artery stenosis due to atherosclerosis
Patients with Cushing’s syndrome (CS) are prone to hypertension as cortisol stimulates renal reabsorption of sodium and enhances vascular sensitivity to catecholamine and angiotensin II.
Conn’s syndromes
Causes:
Other:
- How does obstructive sleep apnoea cause HTN?
- What may be causing HTN in pregnancy?
- Narrowing of the aorta can cause HTN within the heart. What is this called?
Apnoeic episodes lead to sympathetic nervous system spikes - Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system.
Pre-eclampsia
Coarctation of the aorta
Causes:
Medication: C E L E S S
Cyclosporin Estrogen (OCP) Liquorice EPO - used by athletes Steroids Sympathomimetics (e.g. cocaine)
Symptoms are only present in severe disease!
What is the main symptom?
Why does it cause blurred vision?
Symptoms suggesting secondary cause? - 2
Hypertensive retinopathy:
- They get AV nicking. What is it?
- What other signs would you see on the retina? - 2
- What would you see on optic disc?
Headache
High blood pressure can damage the tiny, delicate blood vessels that supply blood to your eyes, causing: Damage to your retina (retinopathy). Damage to the light-sensitive tissue at the back of your eye (retina) can lead to bleeding in the eye, blurred vision and complete loss of vision.
Postural hypotension - vasovagal dysfunction
Palpitations
Sweating - MI
Arteriovenous nicking, also known as AV nicking, is the phenomenon where, on examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which results in the compression of the vein with bulging on either side of the crossing.
Cotton wool spots and flame haemorrhages
Papilloedema
Investigations:
Clinical BP:
In what type of patient should a manual reading be taken?
Ambulatory BP monitoring:
- How many measurements does it take every hour?
- This is usually done for higher BP’s (140/90 mmHg and 180/110 mmHg)!
Home BP monitoring if ABPM declined:
- How many times a day do you do it?
- How long are measurements done for?
When should BP monitoring not be used?
A patient with an arrhythmia
> 2 an hour in waking hours
2 consecutive measures 1 minute apart each time, once AM and once PM
4-7 days
Don’t use in AF
Investigations:
End organ damage to eyes, heart and kidneys:
- what would you do to look for eye damage
- what would you check to see heart function
- what would you check for kidney function in HTN
At what BP should a person be referred for specialist assessment and assessment of target organ damage?
What 10 yr CVD risk score is used and what does it contain?
Eyes - retinopathy - fundoscopy
Heart - check for LVF on ECG
Kidney - urine dip (blood and proteinuria) U+E,
protein (albumin):creatinine ratio
180/110 mmHg or higher.
QRISK2
Glucose
Lipids
Clinical BP
Management - Check NICE guidelines:
<55 years old/not black - ACTS
- Step 1
- Step 2
- Step 3
- Step 4
ACEi (ARB if they get a dry cough)
CCB or Thiazide/thiazide-like diuretics
Combine all 3 (ACEi/ARB, CCB and diuretics)
Spironolactone
Management - Check NICE guidelines:
> 55 years old / afro-carribean - CATS
- Step 1
- Step 2
- Step 3
- Step 4
CCB
ACEi/ARB or Thiazides/thiazide-like diuretics
Combine all 3 (ACEi/ARB, CCB and diuretics)
Spironolactone
Management - Check NICE guidelines:
What can be added if someone has HF?
What can be added if someone has tachycardia?
Give an example of the following:
ACEi ARB CCB Beta-blocker Thiazide-like Thiazide
Beta blockers
Beta blockers
Lisinopril Losartan Amlodipine Bisoprolol Chlorthalidone or Indapamide Bendroflumethiazide/hydrochlorothiazide
Management - Check NICE guidelines:
Why are ACEi not recommended for black people?
They are not sensitive to it apparently - look up
Management - Check NICE guidelines:
BP targets if:
< 80 years old without T1/T2 DM with end organ damage
< 80 years old with T1/T2 DM with end organ damage
> 80 years old
140/90 (135/85 on ABPM)
130/80
150/90 (145/85 on ABPM)
Management - Check NICE guidelines:
Monitoring:
- How often is this done?
- Where is it done?
- What is white coat HTN?
What meds are used during pregnancy? - 3 - L, M, N
Lifestyle changes?
Annually
In clinic
H/ABPM is used if white colour
Labetalol
Methyldopa
Nifedipine
Smoking
Alc
Reduce weight
Salt restriction
Stages of HTN:
Stage 1:
What is the minimum BP for stage 1 in clinic? What about A/HBPM?
What is the first line Rx?
What if the patient is < 80 yrs old and has kidney disease, DM, CVD or end organ damage?
140/90
135/85
Lifestyle changes
Medication
Stages of HTN:
Stage 2:
What is the minimum BP for stage 2 in the clinic? What about A/HBPM?
What is the first line Rx?
Stage 3:
What is the minimum systolic for stage 3/severe HTN?
What is the minimum diastolic for stage 3/severe HTN?
If either systolic or diastolic reach this criteria, then medication needs to be started ASAP!!!
What can be done just to confirm this high BP reading?
160/100
150/95
Meds
> 180 systolic OR >110 diastolic
Meds but do ABPM just to confirm
