HYPERTENSION Flashcards
What is hypertension?
A blood pressure over 140/90mmHg
What is Primary and Secondary Hypertension? Which is most common?
Primary - develops over time without identifiable causes
Secondary - occurs quickly and becomes more severe and is due to an underlying condition
What are the 3 stages of hypertension?
Stage 1: 135/85 to 149/94
Stage 2: 150/95 to 180/119
Stage 3: >180/120
What is severe (stage 3) hypertension?
Hypertensive Urgency or Hypertensive Emergency
What is Hypertensive Urgency?
Stage 3 hypertension without target organ damage
What are the symptoms of hypertension urgency? How do you manage it?
Severe headache, bradypnoea, noise bleed (epistaxis), severe anxiety
Oral medication, observe patient in Outpatient
What is the symptoms with Hypertension Emergency? How do you manage it?
Chest pain, bradypnoea, numbness, weakness, vision change, difficulty speaking
Manage with IV Medication (because it’s faster) and monitor in ICU
What is Hypertensive Emergency?
Stage 3 Hypertension with target organ damage
What is the name of the serious condition that can occur during Hypertensive Emergency?
Encephalopathy
Cerebral arterial slide ability to regulate blood flow to capillaries > cerebral oedema > increase cerebral pressure > brain dysfunction
What are the common renal causes of secondary hypertension?
Diabetic Nephropathy - damage to kidney filtering system > high creatinine and abnormal urinalysis
Polycystic Kidney Disease - cysts form in kidney causing enlargement
Glomerulonephritis - inflammation of glomerular > sodium retention > fluid overload
What are common endocrine causes of Secondary Hypertension?
Cushing’s Syndrome - hypercortisolemia > hyperactive RAAS and suppression of vasodilator system
Pheochromocytoma - rare rumour of the adrenal gland > increase Epinephrine and Norepinephrine > increase peripheral and coronary vasoconstriction (check meta nephrons in urine or serum catecholamines)
Primary Aldosteronism - loss of potassium and retention of sodium > increase blood volume and pressure
Hyperthyrodism - T3 increase C. Output by increasing left ventricular contractility > Systolic Hypertension
Hypothyroidism - decreased release of endothelial-derived relaxing factor > promotes contraction > increase peripheral vascular resistance
How does Coarctation of the Aorta lead to secondary hypertension?
Aorta is narrowed which cause the heart to pump more harder
You will see a high BP in the arms and a delayed femoral pulse, low or unobtainable BP in the legs
What is Cushing’s Syndrome and how does it lead to hypertension?
Condition caused by hypercortisolemia
Too much glucocorticoids causes activation of RAAS and suppression of vasodilatory system
What is Pheochromocytoma and How does it cause hypertension?
Rare tumour of the adrenal gland tissue causing increased epinephrine and norepinephrine
This leads to increased vasoconstriction, heart rate and blood pressure
What are the top symptoms of hypertension?
flushing
Dizziness
Blood in the Urine
Headaches
Nosebleed
What are the physical examination of the Hypertension?
Dyspnoea
Decreased visual acuity and Papilloedema
BP > 140/90 mmHg
What are the top risk factors of Hypertension?
> 65yo
Alcohol
Tobacco
High salt diets
Lack of exercise
family History of Hypertension or CAD
Diabetes
Black ancestry
When is a ABPM offered?
BP between 140/90 - 180/120 mmHg
Used to confirm diagnosis
2x reading per hour throughout a normal working day
What is a HBPM?
It is an alternative to ABPM to diagnosis hypertension
2 consecutive reading 1min apart 2x per day for 4-7days
What are the tests for assessing Target Organ Damage?
Lipid Panel
U&E, eGFR
Urinalysis
HbA1c (anaemia or polycythaemia - renal failure)
ECG (left ventricular hypertrophy or old infarction - talk QRS complex, v1-3 ST elevation, v4-6 inverted T waves)
QRISK3 SCORE (risk of CVD - at 10% begin treatment to prevent CVD)
What is the first line management of Hypertension?
ACEi or ARB if under 55yo or diabetic (Lisopril or Candesartan)
CCB if over 55yo or Black ancestry (amlopdine)
What is the second line treatment of Hypertension?
First line + CCB/THIAZIDE DIURETIC if under 55yo or diabetic ( Diuretic = chortalidone)
First Line + ACEi/ARB or DIURETIC of over 55yo or black ancestry
What is the final step treatment if hypertension is resistant?
low-dose spironolactone (blood potassium <4.5mmol/l)
alpha or beta blocker (blood potassium >4.5mmol/l)
What are the complications of Hypertension?
Hypertensive Retinopathy - thickening of retinal artery walls = swelling
Hypertensive Cerebrovascular Disease - encephalopathy and haemorrhage
Left Ventricular Hypertrophy
Ischaemic Heart Disease
Hypertensive nephropathy - nephrosclerosis
