Hypertension Flashcards
Stage 1 hypertension
Clinic BP: 140/90mmHg-160/100mmHg
Ambulatory daytime average or home blood pressure average: 135/85mmHg or higher
Stage 2 hypertension
Clinic BP: 160/100-180/120mmHg
Ambulatory daytime average or home blood pressure average: 150/95mmHg or higher
Treat ALL regardless of age
Severe hypertension
Clinic systolic BP of 180 or higher or a clinic diastolic BP of 120mmHg or higher
Treat PROMPTLY, same day specialist referral
Stage 1 hypertension
Offer treatment if less than 80 and have one or more of the following:
- Target organ damage (e.g. LV hypertrophy, CKD, or hypertensive retinopathy)
- Established CVD
- Renal disease
- Diabetes
- 10 year CV risk >10%
Ischaemic stroke or Haemorrhagic stroke or TIA
Antihypertensive treatment should be offered even when their baseline blood pressure is at a level that would be considered conventionally normotensive (SIGN 2017)
Aspirin
- Reduces risk of CV events and MI
- High BP must be controlled before aspirin is given
- Unless contra-indicated aspirin is recommended for all patients with established cardiovascular disease
BP target for patients under 80
Clinic= 140/90 mmHg Ambulatory/home= 135/85 mmHg
BP target for patients over 80
Clinic=150/90mmHg
Ambulatory/home=145/85mmHg
Step 1 treatment for hypertension
-Under aged 55 who are not of black african or african caribbean family origin= ACEi or ARB (Do not combine both for hypertension)
-For people aged 55, or of black african or african caribbean family origin= CCB. If CCB is CI then offer a thiazide-like diuretic such as indapamide.
- Those of any age or origin but with type 2 diabetes= ACEi or ARB
- If evidence of heart failure= Thiazide like diuretic
If starting or changing diuretic treatment then choose a thiazide like diuretic over a conventional thiazide diuretic such as bendroflumethiazide.
Step 2 hypertension treatment
-Before next step ALWAYS check if taking medicine as prescribed If on ACEi or ARB as step 1, then ADD: -Either a CCB or -Thiazide like diuretic If on CCB as step 1 then ADD: -ACEi or ARB or -Thiazide like diuretic
Step 3 hypertension treatment
Combination of:
- ACEi/ARB, CCB AND thiazide like diuretic
Step 4 hypertension treatment
Resistant hypertension
- Seek specialist advice
- For people with K+ level of 4.5mmol/L or less, consider low dose spironolactone (OFF-LABEL indication) NB: Up dose titration is not recommended for the treatment of hypertension alone–> Monitor Na+ and K+ and renal function within 1 month of starting
- For people with K+ level of more than 4.5mmol/L, consider an alpha-blocker or beta-blocker
Choice of beta-blockers in hypertension
For people with HT and heart failure: Bisoprolol, carvedilol or nebivolol may be preferred
For people with HT with hypertension and angina: Atenolol, bisoprolol or metoprolol may be preferred
For people with HT who have had previous MI (without HF): metoprolol (standard releasE), propranolol (standard release), timolol or atenolol may be preferred
Beta-blocker and verapamil
DO NOT PRESCRIBE= Can cause bradycardia, asystole, severe hypotension and heart failure can occur
Beta-blocker and diltiazem
AVOID= can cause heart block
