hypertension and heart failure Flashcards
stages of hypertension
>140/90 = stage 1 >160/100 = stage 2 >180/110 = severe
symptoms of accelerated malignant hypertension
headache visual impairment renal impairment cardiac failure neurological signs
risk factors for essential hypertension
idiopathic family risk factors diet obesity alcohol metabolic syndrome low birth weight excess salt intake
commonest cause of secondary hypertension?
renal conditions like diabetic nephropathy, chronic glomerulonephritis, renovascular disease, adult PCKD
what are some endocrine causes of secondary hypertension
endocrine - conns syndrome, adrenal gland hyperplasia, cushings syndrome, phaeochromocytoma, acromegaly, thyroid disease
how to investigate hypertension?
exclude secondary causes - bloods, imaging, urine tests, BM, lipids, ecg.
how to further ivnestigate primary hypertension
clinic bp, ambulatory bp, home bp monitoring
what else to do once essential hypertension is diagnosed
investigate target organ disease e.g. kidneys, heart, eyes
and do cardiovascular risk assessment
complications of hypertension
stroke hypertensive nephrosclerosis dissecting aortic aneurysm hypertensive retinopathy peripheral vascular disease
NICE indications for treating hypertension
under 80 with stage 1 htn and with one of following
target organ damage cdvs disease renal disease diabetes 10 year cdvs risk >20%
anyone with stage 2 hypertension
what should be done with under 40 year old with hypertension
suspect secondary causes, refer to specialist
medical steps in hypertensive treatment
if not >55 or afro-carribean, offer ACEI first. if >55 or afrocarribean, offer CCB or Diuretic
2nd line add CCB or diuretic, or ACEI
3rd line, add all three
4th line, consider alpha blocker, spironolactone, beta blocker and seek specialist advise
what to monitor once if on spironolactone
sodium, potassium
adverse effects of ACEI
hypotension, dry cough, angioedema, renal failure
adverse effects of ARBs
hypotension, dizziness, hyperkalaemia
adverse effects of beta blocker
bronchospasm, postural hypotension, bradycardia
adverse effects of CCB
reflexy tachycardia, hypotension, headache
adverse effects of loop diuretic
hypokalaemia, metabolic alkalosis, hypovolaemia
adverse effects of thiazide diuretics
hypokalaemia, hyponatraemia, hypercalcaemia, hypovolaemia, metabolic alkalosis
adverse effects of spironolactone
hyperkalaemia
NSAIDs is safe to be used with ACEI - T or F
False, nephrotoxic
drugs that can cause hypertension
amphetamines, cold/flu remedies
cocaine, cocp, erythropoetin, anabolic steroids
why does hypertension occur with age
stiffening of arteries, increased serum sodium
drug prescribing guidelines for hypertension
ACEI/ARB for white and <55, CCB for black/>55
add on CCB or ACEI
add on thiazide diuretic (if cannot diuretic, add alpha or beta blocker)
add spironolactone is K ≤4.5 or increase TD dose if K >4.5
