Hypertension Flashcards
Define hypertension
Systolic >140 mm Hg &/or diastolic >90 mm Hg measured on 3 separate occasions
Define malignant hypertension
BP >200/130 mm Hg
Aetiology of primary hypertension
2
Essential or idiopathic hypertension
Responsible for >90% cases
Aetiology of secondary hypertension
5 groups
Renal Endocrine Cardiovascular Drugs Pregnancy
Aetiology of secondary hypertension - renal
5
Renal artery stenosis Chronic glomerulonephritis Chronic pyelonephritis Polycystic kidney disease Chronic renal failure
Aetiology of secondary hypertension - endocrine
7
Diabetes mellitus Hyperthyroidism Cushing’s syndrome Hyperparathyroidism Phaeochromocytoma Congenital adrenal hyperplasia Acromegaly
Aetiology of secondary hypertension - cardiovascular
2
Coarctation of the aorta
Increased intravascular volume
Aetiology of secondary hypertension - drugs
3
Sympathomimetics
Corticosteroids
COCP
Aetiology of secondary hypertension - pregnancy
Pre-eclampsia
Epidemiology of hypertension
prevalence, location
VERY COMMON
10-20% adults of Western world
Presenting symptoms of hypertension
3
Often ASYMPTOMATIC
Symptoms of complications
Symptoms of cause
Presenting symptoms of accelerated/malignant hypertension
6
Scotomas (visual field loss) Blurred vision Headaches Seizures N&V Acute heart failure
Signs of hypertension of physical examination
5
BP should be measured on 2-3 different occasions before diagnosing hypertension
Lowest reading should be recorded
Examination may reveal information about cause:
Radio-femoral delay = coarctation of aorta distal to the left subclavian artery
Renal artery bruit = renal artery stenosis
Fundoscopy to detect hypertensive retinopathy
Keith-Wagner classification of hypertensive retinopathy
4
i. Silver wiring
ii. As above + arteriovenous nipping
iii. As above + flame haemorrhages + cotton wool exudates
iv. As above + papilloedma
Investigations for hypertension
5 groups
Bloods
Urine dipstick
ECG
Ambulatory BP monitoring
Other investigations may be performed if 2º cause of hypertension is suspected (e.g. renal angiogram)
Investigations for hypertension - bloods
3
U&Es
Glucose
Lipids
Investigations for hypertension - urine dipstick
Blood & protein (e.g. if glomerulonephritis)
Investigations for hypertension - ECG
May show signs of left ventricular hypertrophy or ischaemia
Investigations for hypertension - ambulatory BP monitoring
Exclude white coat hypertension
Management of hypertension
6 groups
Conservative
Investigate for 2º causes (mainly in young patients)
Medical
Target BP
Severe hypertension management
Acute malignant hypertension management
Management of hypertension - conservative
4
Stop smoking
Lose weight
Reduce alcohol intake
Reduce dietary sodium
Management of hypertension - medical
2 general, 4, 2, 3, 2
Treatment recommended if systolic >160 mm Hg &/or diastolic >100 mm Hg, or if evidence of end organ damage
Multiple drug therapies often needed
ACE inhibitors or angiotensin receptor blockers 1st line if: <55 yrs Diabetic Heart failure Left ventricular dysfunction
CCBs 1st line if:
>55 yrs
Black
(thiazide diuretic can be used if not tolerated)
β-blockers Not preferred initial therapy May be considered in younger patients May increase risk of heart failure (combing w/ thiazide diuretic may increase risk of developing diabetes)
α-blockers
4th line
May be used in patients w/ prostate disease
Management of hypertension - target BP
3
Non-diabetic: <140/90 mm Hg
Diabetes without proteinuria: <130/80 mm Hg
Diabetes with proteinuria: <125/75 mm Hg
Management of hypertension - severe hypertension management
2
Atenolol
Nifedipine
