Hypertension Flashcards
What is hypertension?
BP > 140/90 mmHg
What is essential hypertension?
- Hypertension with no identifiable underlying cause
What is secondary hypertension?
- Hypertension with an identifiable underlying cause
Identify a vascular cause of secondary hypertension
- Coarctation of the aorta
- Renal artery stenosis
Identify a two renal causes of secondary hypertension
- Chronic pyelonephritis
- Diabetic nephropathy
- Glomerulonephritis
Identify three endocrine cause of secondary hypertension
- Primary hyperaldosteronism
- Phaeochromocytoma
- Cushing’s Syndrome
- Acromegaly
- Hypothyroidism
What is stage 1 hypertension?
- 140/90 to 159/99
What is stage 2 hypertension?
- 159/99 to 179/119
Identify three risk factors for hypertension?
- Increasing age
- Male gender
- BAME
- Smoking
- Excess dietary salt
- Excess alcohol
- Obesity
- Lack of exercise
- Anxiety
Identify three complications of hypertension
- Heart failure
- Coronary artery disease
- Peripheral arterial disease
- Chronic kidney disease
- Stroke
- Vascular dementia
How is hypertension diagnosed?
- Clinic BP > 140/90
AND
- ABPM or HBPM > 135/85
Identify 3 investigations of target organ damage
- Fundoscopy
- ECG
- Urinalysis
What tool should be used to assess 10 year risk of developing cardiovascular disease?
- QRISK
Identify the criteria for urgent specialist assessment of end organ damage
- Stage 3 hypertension in addition to
- Retinal haemorrhage or papilloedema
- New onset confusion, chest pain, signs of heart failure or AKI
What is the first line management of stage 1 hypertension?
- Lifestyle advice
Identify three lifestyle changes
- Healthy diet
- Regular exercise
- Low sodium diet
- Smoking cessation
- Reduced alcohol
Identify three criteria for commencing antihypertensive drugs in stage 1 hypertensionn?
- Target organ damage
- Cardiovascular disease
- Renal disease
- Diabetes
- QRISK > 10%
What is the first line treatment for stage 2 hypertension?
- Antihypertensive drugs in addition to lifestyle changes
What is the first line antihypertensive drug for a person under 55?
- ACE inhibitor (ramipril)
- ARB (losartan) if ACE inhibitor is not tolerated
What is the first line antihypertensive drug for a person over 55?
- CCB (amlodipine)
OR
- Thiazide like diuretic (indapamide) if CCB is not tolerated
What is the first line antihypertensive drug for a person of African or Caribbean descent?
- CCB (amlodipine)
OR
- Thiazide like diuretic (indapamide) if CCB is not tolerated
What is the first line antihypertensive drug for a person with diabetes?
- ACE inhibitor (ramipril)
- ARB (losartan) if ACE inhibitor is not tolerated
What is the second line treatment in hypertension?
- ACE inhibitor + CCB
- ARB instead of ACEI if poorly tolerated or black African or Caribbean
What is the third line treatment in hypertension?
- ACE inhibitor + CCB + thiazide diuretic
What is the fourth line treatment for hypertension?
- If K+ < 4.5: Spironolactone
- If K+ > 4.5: Alpha blocker or beta blocker
What is the target blood pressure for people under 80?
- 140/90 on CBP
- 135/85 on AMBP/HMBP
What is the target blood pressure for people over 80?
- 150/90 on CBP
- 145/85 on AMBP/HMBP
When should a statin be offered?
- QRISK > 10%
Identify three causes of hypertension with hypokalaemia
- Primary hyperaldosteronism
- Cushing’s syndrome
- Liddle’s syndrome
- 11B hydroxylase variant of congenital adrenal hyperplasia
What is malignant hypertension?
- Blood pressure greater than 180/120 with signs of retinal haemorrhage and new target organ damage
Identify three risk factors for malignant hypertension?
- Inadequately treated hypertension
- Chronic kidney disease
- Renal artery stenosis
- Renal transplant
- Pregnancy
Identify three clinical features of malignant hypertension
- Visual changes
- Headache
- Nausea
- Chest pain
- Shortness of breath
- Haematuria
- Oliguria
- Nosebleeds
Identify three investigations in malignant hypertension
- U&E: Raised urea and creatinine
- Urinalysis: Protein; RBCs
- ECG: Ischaemic changes
- CXR: Pulmonary oedema
Outline the management of malignant hypertension
- IV labetalol
- Reduce BP slowly
- No more than 25% within 24 hours
- To prevent acute ischaemia
Identify three adverse effects of ACE inhibitors
- Dry cough
- Hypotension
- Hyperkalaemia
- Renal failure
What is the dose and administration of ramipril?
- 1.25 - 2.5 mg once daily
- By mouth
Identify three adverse effects of dihydropyridines
- Oedema
- Flushing
- Headaches
- Palpitations
What is the dose and administration of amlodipine?
- 5 mg once daily
- By mouth
Identify three adverse effects of thiazide diuretics
- Hyponatraemia
- Hypokalaemia
- Arrhythmia
- Erectile dysfunction
- Agranulocytosis
- Worsening of gout
What is the dose and administration of indapamide?
- 2.5 mg once daily
- Orally
Identify two adverse effects of spironolactone
- Gynaecomastia
- Hyperkalaemia
What is the dose and administration of spironolactone?
- 25 mg once daily
- By mouth
Identify three adverse effects of alpha blockers
- Postural hypotension
- Dizziness
- Syncope
What is the dose and administration of doxazosin?
- 1 mg initially
- By mouth
Identify three adverse effects of beta blockers
- Fatigue
- Cold extremities
- Headache
- Nausea
- Nightmares
- Impotence
Identify a contraindication of beta blockers
- Asthma
Identify the dose and administration of atenolol
- 25 - 50 mg once daily
- By mouth
