Hypertension Flashcards
What are some causes of secondary hypertension?
Renal disease Endocrine disease Aortic disease e.g. coarctation (narrowing) Renal artery stenosis Drug therapy e.g. steroids
How does renal disease cause hypertension?
Reduced renal blood flow
Excess renin release
Salt and water overload
Give some examples of endocrine causes of hypertension
Adrenal gland hyperfunction/tumour
Conn’s syndrome –> increased aldosterone
Cushing’s syndrome –> increased corticosteroid
Phaeochromocytoma –> increased noradrenaline
How does benign hypertension present?
Asymptomatic, incidental finding on routine health check
What are some possible consequences of untreated benign hypertension?
Left ventricular hypertrophy Heart failure Atherosclerosis Aneurysm rupture Renal disease Microvascular changes e.g. retina, kidney
How id malignant hypertension defined?
Diastolic pressure > 130/140
Serious, life threatening condition
What are some presenting features of malignant hypertension?
Cerebral oedema (seen as papilloedema) Acute renal failure Acute HF Headache Cerebral haemorrhage
If using an automated device to measure BP, what must you check first?
Check if pulse is regular
–> if irregular, measure BP manually
How is hypertension diagnosed?
Must use either:
- ambulatory BP monitoring (ABPM)
- OR home BP monitoring (HBPM)
How many measurements should be taken when using ABPM?
At least 2 measurements per hour during waking hours
–> at least 14 per day
How many measurements should be taken when using HBPM and how is the average worked out?
2 consecutive seated measurements, 1 minute apart
Recorded twice a day (morning and evening)
For at least 4 days, ideally 7 days
Discard first day readings, take average of the rest
How is stage 1 hypertension defined?
Clinic BP 140/90 or higher AND
ABPM/HBPM average 135/85 or higher
How is stage 2 hypertension defined?
Clinic BP 160/100 or higher AND
ABPM/HBPM average 150/95 or higher
How is severe hypertension defined?
Clinic systolic BP 180 or higher OR
Clinic diastolic BP 110 or higher
How should you assess a patient with newly diagnosed hypertension in order to assess risk and end organ damage?
- assess risk with ASSIGN score
- urine for proteinuria
- blood for HbA1c, electrolytes, creatinine, eGFR + cholesterol
- fundoscopy for hypertensive retinopathy
- 12 lead ECG
What are the two main options for management of hypertension?
Lifestyle advice
Antihypertensive drugs
What is the criteria for starting antihypertensive medication?
Stage 2 hypertension (clinic > 160/100, ABPM > 150/95) Stage 1 hypertension with 1 or more of: - target organ damage - established CVD - renal disease - diabetes - estimated 10 year risk 10% or more
What should target BP be in most patients?
< 130/80 if tolerated
Which drug is first line in Caucasian patients aged < 55?
ACE inhibitor
Which drug is first line in Caucasian patients aged > 55?
Calcium channel blocker
Which drug is first line in patients with diabetes?
ACE inhibitor
Which drug is first line in patients of African or Caribbean origin of any age?
Calcium channel blocker
What is step 2 in the management of hypertension?
ACE inhibitor + Calcium channel blocker
What is step 3 in the management of hypertension?
A + C + thiazide like diuretic (e.g. indapamide)
Which drugs should you consider adding in step 4 in the management of hypertension?
Further diuretic (spironolactone)
Alpha blocker
Beta blocker
Which drugs should be used to treat hypertension in pregnancy?
methyldopa or labetolol
