Hypertension Flashcards
define hypertension
a persistently raised arterial blood pressure >140/90mmHg in clinic or >135/85mmHg ambulatory
types of hypertension
primary (90%) - no underlying cause
secondary - identifiable cause
classification of hypertension
stage I - >140/90mmHg or average 135/85mmHg
stage II - >160/100mmHg or average >150/95mmHg
stage III - systolic >180mmHg and diastolic >110mmHg
investigations of hypertension
ambulatory BP (2 measurements per waking hour) monitoring
home BP (2 measurements 2x daily for 4-7days) monitoring
assessment of end-organ damage risk
what investigations are involved in end-organ damage risk?
urine dip albumin:creatine level bloods - glucose, lipids and RFTs ECG - evidence of LV hypertrophy fundoscopy - hypertensive retinopathy
conservative management of hypertension
control risk factors: weight loss healthy diet (low saturated fat and salt) reduce alcohol and caffeine reduce stress smoking cessation
indications to start pharmacological intervention in stage I hypertension
<80 yrs with end-organ damage CVD, renal disease diabetes 10yr CVS risk >20%
indications to start pharmacological intervention in hypertension
stage II hypertension and/or type II diabetes
first line anti-hypertensive if <55yrs or Type II diabetes
ACE inhibitor (e.g. ramipril or perindopril)
A2RB
(e.g. losartan, valsartan and candesartan)
side effects of ACE inhibitors and contraindications
cough, angioedema and hyperkalaemia
DO NOT USE IN PREGNANT WOMEN
indications for use of A2RBs
intolerance of ACE inhibitors
younger patients
first line anti-hypertensive if >55yrs or Afro-Caribbean descent
calcium-channel blockers
e.g. nefedipine and amlodipine
side effects of CCBs and contraindications
flushing, ankle swelling and headaches
NOT used in those with PMH of acute MI and HF
what happens if first line therapy fails/intolerated in hypertension?
combine CCB and ACE/A2RB
what happens if maximal dose of CCB, ACE/A2RB therapy fails/intolerated?
add thiazide-like diuretic
e.g. indapamide or clortalidone