Hypertension Flashcards
Define Hypertension?
Systolic > 140 mm Hg and/or diastolic > 90 mm Hg measured on three separate occasions
Define Malignant Hypertension?
BP > 200/130 mm Hg
What is the primary aetiology of Hypertension?
Essential or idiopathic hypertension
Responsible for > 90% of cases
What are the secondary causes of Hypertension?
Renal Causes Endocrine Causes Cardiovascular Causes Drugs Pregnancy
What are the Renal Causes of Hypertension?
Renal Artery Stenosis Chronic Glomerulonephritis Chronic Pyelonephritis Polycystic Kidney Disease Chronic Renal Failure
What are the Endocrine Causes of Hypertension?
Diabetes Mellitus Hyperthyroidism Cushing's Syndrome Conn's Syndrome Hyperparathyroidism Phaeochromocytoma Congenital Adrenal Hyperplasia Acromegaly
What are the Cardiovascular causes of Hypertension?
Coarctation of the aorta
Increased intravascular volume
What drugs can cause Hypertension?
Sympathomimetics
Corticosteroids
COCP
How can Pregnancy cause Hypertension?
Pre-eclampsia
What are the presenting symptoms of Hypertension?
Often Asymptomatic
Symptoms of Complications
Symptoms of the cause
What are the presenting symptoms of Accelerated or Malignant Hypertension?
Scotomas (visual field loss) Blurred Vision Headache Seizures Nausea and Vomiting Acute Heart Failure
What are the signs of Hypertension on examination?
BP should be measured on 2-3 different occasions before diagnosing Hypertension
The lowest reading may be recorded
How can Examination reveal information about the causes of Hypertension?
Radiofemoral delay = Coarctation of the aorta distal to the left subclavian artery
Renal Artery Bruit = Renal Artery Stenosis
Fundoscopy to detect hypertensive retinopathy
What is Keith-Wagner Classification of Hypertensive Retinopathy?
I - Silver wiring
II - As above + arteriovenous nipping
III - As above + flame haemorrhages + cotton wood exudates
IV - As above + papilloedema
What bloods would you do for Hypertension?
U&Es
Glucose
Lipids
What would you look for on a Urine Dipstick in Hypertension?
Blood and Protein (e.g. if glomerulonephritis)
What would you look for on a ECG for Hypertension?
May show signs of Left Ventricular Hypertrophy or ischaemia
Why might you do an Ambulatory BP monitoring?
Excludes white coat hypertension
Why might we do other investigations?
If a secondary cause of the Hypertension is suspected
What is the conservative management plan for Hypertension?
Stop smoking Lose weight Reduce alcohol intake Reduce Dietary Sodium Investigate for secondary causes (mainly in young patients)
When is medical treatment needed for Hypertension?
If systolic > 160 mm Hg and/or diastolic > 100 mm Hg or if evidence of end-organ damage
Multiple drug therapies often needed
What are the different lines of drug treatment we can do for Hypertension?
ACE inhibitors or ARB blockers
CCBs
Beta-Blockers
Alpha-Blockers
When are ACE inhibitors/ ARB receptor blockers first line treatment for Hypertension?
< 55 years
Diabetic
Heart Failure
Left Ventricular Dysfunction
When are CCBs first line treatment for Hypertension?
> 55 yrs
Black
What can be used if CCBs are not tolerated for Hypertension treatment?
Thiazide Diuretics
What are the characteristics of Beta-Blocker usage for Hypertension treatment?
Not preferred initial therapy
May be considered in younger patients
Combining with thiazide diuretic may increasing risk of developing diabetes
May increase risk of heart failure
What are the characteristics of Alpha-Blocker usage for Hypertension treatment?
4th line
May be used in patients with prostate disease
What is the target BP in a non-Diabetic patient with Hypertension?
< 140/90 mm Hg
What is the target BP in a diabetic patient without proteinuria and with Hypertension?
< 130/80 mm Hg
What is the target BP in a diabetic patient with proteinuria and with Hypertension?
< 125/75 mm Hg
What drugs would we use in the treatment of Severe Hypertension Management (Diastolic > 140 mm Hg)?
Atenolol
Nifedipine
What is management of Acute Malignant Hypertension?
IV beta-blocker (e.g. esmolol)
Labetolol
Hydralazine Sodium Nitroprusside
Why should we be careful of rapid lowering of BP in Acute Malignant Hypertension management?
Can Cause Cerebral Infarction
Why can rapid lowering of BP cause Cerebral Infarction?
The autoregulatory mechanisms within the brain for regulating blood flow will cause vasoconstriction of the vessels in the brain when BP is very high
Lowering the BP too rapidly will mean the autoregulatory mechanisms don’t adapt to the drop in BP and so the vessels remain constricted
A rapid drop in BP with constricted vessels will cause an infarction
What are 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
What is the prognosis for patients with Hypertension?
Good prognosis if well controlled
Uncontrolled hypertension if associated with increased mortality
Treatment reduces incidence of renal damage, stroke and heart failure
