Hypertension Flashcards
what reading is diagnostic of hypertension
clinic reading persistently above 140/90
24 hour ambulatory average reading above 135/85
if BP is above 140/90 in clinic, what further investigation is needed?
24 hour ambulatory blood pressure monitoring to confirm diagnosis
stage 1 HTN criteria
clinic BP > 140/90 and ABPM > 135/85
stage 2 HTN criteria
clinic BP > 160/100 and ABPM > 150/95
stage 3 HTN criteria
clinic BP > 180/110
complications of HTN
ischaemic heart disease cerebrovascular incident hypertensive retinopathy hypertensive nephropathy heart failure
what investigations should all patients with new HTN diagnosis receive
urine albumin:creatinine ratio for proteinuria
urine dipstick for microscopic haematuria
bloods for HbA1c, lipids, renal function
fundoscopy for retinopathy
ECG for cardiac abnormalities
step 1 tx patients < 55 years old or with T2DM
ACE inhibitor e.g. ramipril or ARB e.g. losartan if ACE not tolerated
step 1 tx patients > 55 years old or afro-carribean ethnicity
Calcium channel blocker e.g amlodipine
step 2 tx
if taking ACEI – add calcium channel blocker / thiazide diuretic
if taking calcium channel blocker – add ACE/ARB
step 3 tx
ACEI + Calcium channel blocker + thiazide diuretic
step 4 tx if potassium < 4.5
add spironolactone
step 4 tx if potassium > 4.5
add an alpha (doxazosin) or beta blocker (atenolol)
common side effects of ACEI
cough
hyperkalaemia
angioedema
common side effects of calcium channel blockers
ankle swelling
flushing
headache
common side effects of thiazide diuretics
hypokalaemia
hyponatraemia
common side effects of spironolactone
gynaecomastia
hyperkalaemia
causes of secondary HTN
Renal disease
Obesity
Pregnancy induced / pre-eclampsia
Endocrine e.g Conns syndrome (HTN + low K)
test for conns syndrome
renin: aldosterone ratio
- high aldosterone levels, low renin
