Hypertension Flashcards

1
Q

define hypertension

A

a persistently raised arterial blood pressure >140/90mmHg in clinic or >135/85mmHg ambulatory

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2
Q

types of hypertension

A

primary (90%) - no underlying cause

secondary - identifiable cause

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3
Q

classification of hypertension

A

stage I - >140/90mmHg or average 135/85mmHg

stage II - >160/100mmHg or average >150/95mmHg

stage III - systolic >180mmHg and diastolic >110mmHg

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4
Q

investigations of hypertension

A

ambulatory BP (2 measurements per waking hour) monitoring

home BP (2 measurements 2x daily for 4-7days) monitoring

assessment of end-organ damage risk

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5
Q

what investigations are involved in end-organ damage risk?

A
urine dip 
albumin:creatine level
bloods - glucose, lipids and RFTs
ECG - evidence of LV hypertrophy
fundoscopy - hypertensive retinopathy
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6
Q

conservative management of hypertension

A
control risk factors:
weight loss
healthy diet (low saturated fat and salt)
reduce alcohol and caffeine 
reduce stress
smoking cessation
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7
Q

indications to start pharmacological intervention in stage I hypertension

A
<80 yrs with end-organ damage
CVD,
renal disease 
diabetes 
10yr CVS risk >20%
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8
Q

indications to start pharmacological intervention in hypertension

A

stage II hypertension and/or type II diabetes

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9
Q

first line anti-hypertensive if <55yrs or Type II diabetes

A
ACE inhibitor 
(e.g. ramipril or perindopril)

A2RB
(e.g. losartan, valsartan and candesartan)

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10
Q

side effects of ACE inhibitors and contraindications

A

cough, angioedema and hyperkalaemia

DO NOT USE IN PREGNANT WOMEN

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11
Q

indications for use of A2RBs

A

intolerance of ACE inhibitors

younger patients

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12
Q

first line anti-hypertensive if >55yrs or Afro-Caribbean descent

A

calcium-channel blockers

e.g. nefedipine and amlodipine

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13
Q

side effects of CCBs and contraindications

A

flushing, ankle swelling and headaches

NOT used in those with PMH of acute MI and HF

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14
Q

what happens if first line therapy fails/intolerated in hypertension?

A

combine CCB and ACE/A2RB

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15
Q

what happens if maximal dose of CCB, ACE/A2RB therapy fails/intolerated?

A

add thiazide-like diuretic

e.g. indapamide or clortalidone

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16
Q

side effects of thiazide-like diuretics

A

hypnoatraemia, hypokalaemia and dehydration

17
Q

when is spironolactone utilised in hypertension

A

when step 3 has failed and blood K <4.5mmol/L

18
Q

what happens if blood [K+] >4.5mmol/L but step 3 therapy failed?

A
increase dose of thiazide-like diuretic OR 
add: 
alpha blocker
beta blocker 
refer to cardiology
19
Q

define malignant hypertension

A

a syndrome involving severe elevation of arterial BP, causing end-organ damage
(BP >180/120mmHg)

20
Q

clinical features/evidence of malignant hypertension in addition to BP >180/120mmHg

A
papilloedema and/or retinal haemorrhage
new onset confusion
seizure
chest pain
signs of heart failure
acute kidney injury
21
Q

management of malignant hypertension

A

controlled drop in BP to 160/100mmHg with oral CCB (e.g. amlodipine)

22
Q

suspicion for secondary hypertension

A
young patient (under 40)
few comorbidities 
new hypertension 
associated symptoms 
disturbed electrolytes
23
Q

causes of secondary hypertension

A

primary intrinsic kidney disease
renovascular disease
endocrine disease

24
Q

investigations if suspect secondary hypertension

A

renal function
aldosteron:renin ration
24hr urinary
CT/MR angiography