Hypertension Flashcards
What is classed as stage 1 hypertension?
Clinic BP of >140/90 and A/HBPM BP of >135/85
What is classed as stage 2 hypertension?
Clinic BP of >160/100 and A/HBPM of >150/95
What is classed as stage 3 or severe hypertension?
Clinic systolic BP of 180+ or diastolic BP of 120+
What are the causes of hypertension?
None (95%) Renal (e.g. renal artery stenosis) Endocrine (e.g. Cushing's) Drugs (e.g. cocaine) Raised ICP Coarctation of the aorta Pre-eclampsia Fluid overload
What is the difference between an ABPM and a HBPM?
ABPM: assesses daytime and night time BP during routine daily activities over 24 hours
HBPM: assesses blood pressure at specific times during the day and night over a longer period of time
Is ABPM or HBPM usually done?
Usually ABPM
HBPM if ABPM is declined or not tolerated
What clinic blood pressure would cause you to start medication immediately?
180/120 or higher
What further investigations are done in a hypertensive patient?
Urine - haematuria, Albumin:Creatine ratio
Bloods (FBC, U&Es, glucose, lipids)
12 lead ECG
Fundoscopy (hypertensive retinopathy)
What assessment criteria is done in hypertensive patients?
10 year cardiovascular risk, e.g. QRISK score
What lifestyle interventions are recommended for hypertensive patients?
Exercise
Stop smoking
Limit alcohol, salt and caffeine
What is the management if blood pressure is under 135/85 (A/HBPM)?
Check BP at least every 5 years
If evidence of target organ damage consider alternative causes
What is the management if >80 with clinic BP >150/90?
Offer lifestyle advice
Consider drug treatment
What is the management of BP 135/85 to 149/94 if the patient is <80 with target organ damage, CVD, renal disease, diabetes or 10 year CVD risk over 10%?
Offer lifestyle advice
Discuss starting drug treatment
What is the management of BP 135/85 to 149/94 if the patient is <60 with 10 year CVD risk <10%?
Offer lifestyle advice
Consider drug treatment
What is the management of BP 135/85 to 149/94 if the patient is age <40?
Offer lifestyle advice
Consider secondary causes and assess benefits and risks of treatment
What is the management if blood pressure is 150/95 or higher?
Offer lifestyle advice
Discuss treatment
How is hypertension followed up?
Offer annual review
What is the treatment pathway for a hypertensive patient with type 2 diabetes or is age <55 and not of black African or African-Caribbean family origin?
- ACEi or ARB
- ACEi/ARB + CCB or thiazide-like diuretic
- ACEi/ARBB + CCB + thiazide-like diuretic
- Consider addition of spironolactone if K+ <4.5 or alpha blocker or beta blocker if K+ >4.5
What is the treatment plan for hypertension without type 2 diabetes, where patients are age 55 or over, or black African or African Caribbean family origin of any age?
- CCB
- CCB + ACEi/ARB or thiazide-like diuretic
- ACEi/ARBB + CCB + thiazide-like diuretic
- Consider addition of spironolactone if K+ <4.5 or alpha blocker or beta blocker if K+ >4.5
Which patients are first offered ACE inhibitors?
Type 2 diabetes
Age <55 and not black African or African-Caribbean family origin
What is used to monitor treatment?
Clinic BP
What is the blood pressure target for age <80 years?
Clinic BP <140/90
What is the blood pressure target for age >80 years?
Clinic BP <150/90
What is the blood pressure target patients with postural hypertension?
Base target on standing BP
