Hypertension Flashcards
1
Q
Define hypertension
A
Blood pressure over 140/90 measured on three separate occasions
2
Q
What are the causes/risk factors of hypertension?
A
Primary/essential (90-95%)
• Idiopathic
Secondary (5-10%) Vascular • Renal artery stenosis • Aortic coarctation • Pre-eclampsia
Renal • CKD • Polycystic kidney disease • Obstructive uropathy • Nephrotic syndrome • Glomerulonephritis
Endocrine • Primary hyperaldosteronism - Conn’s syndrome • Cushing’s syndrome • Phaeochromocytoma • Hyperthyroidism • Hyperparathyroidism • Acromegaly • Drugs e.g. sympathomimetics (cocaine), corticosteroids, OCP
3
Q
What are the symptoms of hypertension?
A
- Asymptomatic
* Symptoms related to secondary causes
4
Q
What are the signs of hypertension?
A
• Hypertensive retinopathy
Signs related to causes
• Radiofemoral delay
• Renal artery bruit
5
Q
What investigations are carried out for hypertension?
A
• Ambulatory or home BP monitoring • Bloods - U&Es – low K in Conn’s - Creatinine - Glucose – diabetes - Lipids – CV risk assessment • Urine dipstick - Proteinuria – nephrotic syndrome - Haematuria – glomerulonephritis - Glycosuria – diabetes • ECG - LVH - Ischaemic changes • CXR - Hear failure - Aortic coarctation • Special blood tests - Plasma renin:aldosterone ratio – Conn’s - Plasma renin activity – RAS - Dexamethasone suppression test – Cushing’s - TFTs – hyperthyroidism • Special urine tests - 24hr urinary catecholamines – phaeochromocytoma • Renal USS – RAS, PKD • CT adrenals – phaeochromocytoma • Renal biopsy
6
Q
What is the management for hypertension?
A
If secondary, treat the underlying cause!
Conservative • Diet – reduce salt and fat • Exercise • Reduce alcohol consumption • Smoking cessation
Medical – start treating at Stage 2 or Stage 1 with CV risk factors Target BP • <140/90 • <130/80 – diabetic • <125/75 – diabetic with proteinuria
Malignant hypertension
• Beta-blocker
• Labetalol
• Hydralazine
Diuretics • Increased urination • Dizziness (postural hypotension) • Hyponatraemia – confusion • Hypokalaemia – flattened T waves, ST depression, prolonged QT • Risk of arrhythmia
Spironolactone • Used in heart failure • Hyperkalaemia • Gynaecomastia • Replace with eplerenone
Beta-blockers • Used in AF • Bronchospasm (X asthma/COPD) • Fatigue • Heart failure • Hypoglycaemia (X diabetes) • Cold extremities
Alpha-blockers
• Used in BPH
7
Q
What are the complications of hypertension?
A
Cardiovascular • Heart failure • Coronary artery disease • MI • Peripheral vascular disease
Cerebrovascular
• Stroke
• Hypertensive encephalopathy
Renal
• Renal failure
Retinopathy • Grade 1 – silver wiring • Grade 2 – plus AV nipping • Grade 3 – plus flame haemorrhages and cotton wool spots • Grade 4 – plus papilloedema
