Hypertension Flashcards
Define HTN
Blood pressure >=140/90 mmHg
HTN causes
> 90% cases = PRIMARY – essential/idiopathic
How do you correctly measure BP in clinic?
Offer to measure in both arms.
If difference between both arms >15mmHg –> repeat + measure from arm with higher BP
If BP >140/90 –> 2nd measurement –> 3rd measurement + record lower of last 2 measurements
Define white coat effect
Discrepancy of more than 20/10mmHg between clinic and average daytime ABPM
Secondary renal causes of HTN
Renal artery stenosis Chronic glomerulonephritis Pyelonephritis Polycystic kidney disease Renal failure
Secondary endocrine causes of HTN
Diabetes Hyperthyroidism Cushing’s Conn’s Hyperparathyroidism Phaeochromocytoma Congenital Adrenal Hyperplasia Acromegaly
Secondary non-renal/endocrine causes of HTN
pre-eclampsia
CARDIO: coarctation of the aorta,increased intravascular volume
DRUGS: sympathomimetics, corticosteroids, oral contraceptives
What is stage 1 HTN?
Clinic BP >=140/90 mmHg
ABPM daytime/HBPM BP >=135/85 mmHg
What is stage 2 HTN?
Clinic BP >=160/100 mmHg
ABPM daytime average/HBPM average BP >=150/95 mmHg
What is stage 3 HTN?
Clinic systolic BP >= 180 mmHg OR
Clinic diastolic BP >= 110 mmHg
What do you do if someone comes into the clinic with BP >140/90?
Offer ABPM or HBPM
If a PT has BP >135/85 (stage 1 HTN) on A/H BPM what is the criteria for management?
(CORD10)
Treat if <80 years AND any of the following:
- Established CVD
- Target Organ damage
- Renal disease
- Diabetes
- 10 year CV risk equivalent to 10% or greater
If a PT has BP >150/95 (stage 2 HTN) on A/H BPM what is the criteria for management?
Treat all patients regardless of age
Management of HTN step 1 (give example)
If <55yr / T2DM:
- ACE-i - ends with ‘-pril’ -eg ramipril
- or ARB if not tolerated- ends with ‘-sartan’
If >55yrs / Afro-caribbean/black African:
- CCB- ends with ‘dipine’- eg amlodipine
Management of HTN step 2
If <55yr / T2DM:
- ACEi/ARB + CCB
OR
- ACEi/ARB + thiazide-like diuretic (bendroflumethiazide)
If >55yrs / Afro-caribbean/black African:
- CCB + ACEi/ARB
OR
- CCB + thiazide-like diuretic (bendroflumethiazide)
Management of HTN step 3
ACEi/ARB + CCB + thiazide-like diuretic
Management of HTN step 4
If K+ <= 4.5 mmol/L: add low-dose spironolactone
If K+ > 4.5 mmol/L: add an alpha- or beta-blocker
If BP not controlled on 4 drugs then specialist review
What lifestyle advice would you offer for hypertension?
Low salt (<6/day, ideally 3g), fruit + veg rich, reduce caffeine intake
Stop smoking
Drink less alcohol
Exercise, lose weight
ACE inhibitor MOA
Inhibit the conversion angiotensin I to angiotensin II
ACE inhibitor side effects
Cough
Angioedema
Hyperkalaemia
Renal failure (RAS)