Hypertension Flashcards
Define hypertension
DEFINITION: systolic > 140 mm Hg and/or diastolic > 90 mm Hg measured on three separate occasions.
Malignant Hypertension: BP > 200/130 mm Hg
Summarise the epidemiology of hypertension
VERY COMMON
10-20% of adults in the Western world
Aetiology/risk factors of hypertension
Primary
- Essential or idiopathic hypertension
- Responsible for > 90% of cases
Secondary
-Renal
Endocrine
Cardiovascular
Drugs
Pregnancy
Renal
Renal artery stenosis
Chronic glomerulonephritis
Chronic pyelonephritis
Polycystic kidney disease
Chronic renal failure
Endocrine
Diabetes mellitus
Hyperthyroidism
Cushing’s syndrome
Conn’s syndrome
Hyperparathyroidism
Phaeochromocytoma
Congenital adrenal hyperplasia
Acromegaly
Cardiovascular
Coarctation of the aorta
Increased intravascular volume
Drugs
Sympathomimetics
Corticosteroids
COCP
Pregnancy
Pre-eclampsia
Recognise the presenting symptoms of hypertension
Often ASYMPTOMATIC
Accelerated or Malignant Hypertension:
- Scotomas (visual field loss)
- Blurred vision
- Headache
- Seizures
- Nausea and vomiting
- Acute heart failure
Recognise the signs of hypertension on physical examination
Radiofemoral delay = coarctation of the aorta distal to the left subclavian artery
Renal artery bruit = renal artery stenosis
Fundoscopy to detect hypertensive retinopathy
Keith-Wagner Classification of Hypertensive Retinopathy
Silver wiring
As above + arteriovenous nipping
As above + flame haemorrhages + cotton wood exudates
As above + papilloedema
Identify appropriate investigations for hypertension
Bloods
Urine Dipstick
ECG
Ambulatory blood pressure monitoring
Bloods
U&Es
Glucose
Lipids
Urine Dipstick
Blood and protein (e.g. if glomerulonephritis)
ECG
May show signs of left ventricular hypertrophy or ischaemia
Ambulatory blood pressure monitoring
Excludes white coat hypertension
Management plan for hypertension
Conservative
Stop smoking
Lose weight
Reduce alcohol intake
Reduce dietary sodium
Management plan for hypertension
Medical
treatment recommended if systolic > 160 mm Hg and/or diastolic > 100 mm Hg, or if evidence of end-organ damage. Multiple drug therapies often needed.
ACE Inhibitors or Angiotensin Receptor Blockers
first line if:
< 55 yrs
Diabetic
Heart failure
Left ventricular dysfunction
CCBs
first line if:
> 55 yrs
Black
NOTE: thiazide diuretics can be used if CCBs are not tolerated
Beta-Blockers
Not preferred initial therapy
May be considered in younger patients
CAUTION: combining with thiazide diuretic may increase risk of developing diabetes
May increase risk of heart failure
Alpha-Blockers
4th line
May be used in patients with prostate disease
Target BP
Non-Diabetic: < 140/90 mm Hg
Diabetes without proteinuria: < 130/80 mm Hg
Diabetes WITH proteinuria: < 125/75 mm Hg
Severe Hypertension Management
Atenolol
Nifedipine
Acute Malignant Hypertension Management:
IV beta-blocker (e.g. esmolol)
Labetolol
Hydralazine sodium nitroprusside
Identify the possible complications of hypertension
Heart failure
Coronary artery disease
Cerebrovascular accidents
Peripheral vascular disease
Emboli
Hypertensive retinopathy
Renal failure
Hypertensive encephalopathy
Posterior reversible encephalopathy syndrome (PRES)
Malignant hypertension
Summarise the prognosis for patients with hypertension
Good prognosis if well controlled
Uncontrolled hypertension associated with increased mortality
Treatment reduces incidence of renal damage, stroke and heart failure
