Hypertension Flashcards
What is primary/essential hypertension?
Hypertension with no clear cause (90%)
What is secondary hypertension?
Hypertension with an underlying cause (10%)
What are the causes of primary hypertension?
- Over time artery pressure raises
- Risk factors – old age, obesity, salt heavy diet, sedentary, lifestyle, alcohol (J shaped), stress, insulin tolerance
- Genetic Factors
- Foetal factors – low birth weight (adaptive changes in uterus to under nutrition)
What are the causes of secondary hypertension?
renal disease, endocrine disease, congenital, neurological, pregnancy, drugs, cardiological causes
what are the renal diseases associated with secondary hypertension?
All renal disease
Particularly - Chronic glomerulonephritis, chronic pyelonephritis, polycystic renal disease, renal artery stenosis
what are the endocrine diseases associated with secondary hypertension?
Cushing’s, conns, adrenal hyperplasia, pheochromocytoma, acromegaly, corticosteroids, tumours
what are the congenital conditions associated with secondary hypertension?
coarctation or aorta
what are the neurological causes associated with secondary hypertension?
Raised ICP, brainstem lesions
what are the drugs associated with secondary hypertension?
oral contraceptives, steroids, NSAIDs, carbenoxolone, sympathomimetic agents, EPO
how can pregnancy cause secondary hypertension?
pre-eclampsia
what are the cardiological diseases associated with secondary hypertension?
atherosclerosis, aortic dissection
What are the other causes of secondary hypertension?
Vasculitis, Fibromuscular dysplasia
what is the definition of mild hypertension?
> 140 systolic or >90 diastolic
what is the definition of moderate hypertension?
160 systolic or >100 diastolic
what is the definition of severe hypertension?
180 systolic or >110 diastolic
what is the definition of benign hypertension?
stable elevation over many years
what is the definition of malignant hypertension?
acute, severe elevation of BP
diagnosed via retinal signs
What is the definition of a hypertensive crisis?
- Systolic >180mmgHg
- Diastolic >120mmgHg
- Urgency – no damage to end organs
- Emergency – damage to end organs
what are the clinical features of primary hypertension
usually none
what are the clinical features of secondary hypertension?
associated with underlying cause
what are the clinical features of emergency hypertension?
confusion, drowsiness, chest pain, breathlessness
how can a diagnosis of hypertension be made?
24 hour Ambulatory BP monitoring = DIAGNOSITIC
• Clinic BP of 140/90 mmHg PLUS
• ABPM or HBPM of >135/95 mmHg
what further investigations should be done in hypertension?
o Bloods – HbA1c, eGFR, cholesterol o Urinalysis o ECG o Fundoscopy o CXR o Aldosterone
what is the first line management of hypertension?
If under 55 – start with an ACE inhibitor (or ARB if ACEi not tolerated)
If over 55 (or of African origin at any age) and don’t have T2DM then start with a calcium channel blocker
(if a calcium channel blocker is not tolerated, use a thiazide diuretic instead)
