Hypertension and scoring systems Flashcards
Cut offs for hypertension
Hypertension stage 1- 140/90 mmHg
Over 80- 150/90
Type 1 diabetes 135/85
Type 2 diabetes 140/80
Risks of high blood pressure
- Heart disease
-Heart attacks - Strokes
- Heart failure
- Peripheral arterial disease
- Aortic aneurysm
- Kidney disease
- Vascular dementia
- Major cause of premature death worldwide
Risk factors for hypertension
- Overweight
- Too much salt
- Not enough fruit/veg
- Sedentary lifestyle
- Excess alcohol or caffeine
- Over 65
- Family history
- Black African or caribbean descent
- Low socioeconomic status
Annual health checks
Offered to people over the age of 80
Do screening for diabetes (HBA1C)
Check BP for hypertension
Might do FBC and LFT- fatty liver disease
U&E- CKD
Lipid profile
Address lifestyle risk factors
HBA1c levels in annual health check
- <42 normal
- 42-48 - pre-diabetes, non-diabetic hyperglycaemia (NDH)
- > 48 diabetes
Stage 1 hypertension
140-159/90-99
Manage lifestyle factors first and try to reduce blood pressure
Only treat if QRISK >10%
Stage 2 hypertension
> 160/>100
Pharmacological treatment
QRISK
The chance of having a cardiovascular event in the next 10 years, anything over 10% is significant
If high QRISK, important to start treatment
Statins are a good drug to reduce QRISK
Statins- when to use/not use
Before starting statins, do LFT to assess liver function and do it after 3 months
If hepatic impairment, statins are not suitable as they are metabolised in the liver by CYP450 enzymes
Offer a statin to anyone with a QRISK >10% even if their cholesterol isn’t particularly raised
Continue using statin unless ALT is more than 3x normal
Disadvantages of statins and what to use if contraindicated
Disadvantages- liver inflammation, muscle side effects, myalgia, rhadomyolysis
What to use if contraindicated- Zetamide
Types of prevention
Primary prevention- aims to prevent a disease before it even occurs. Done in GP and community
Secondary prevention- treating the disease ASAP to minimise complications, secondary care and hospital
Secondary causes of hypertension
- Secondary problems include adrenal gland problems, renal problems, renal artery stenosis, endocrine disorders (primary hyperaldosteronism, hyperthyroidism, hypothyroidism), pheochromocytoma (neuroendocrine tumour)
- If secondary to another disease, tend to be showing systemic symptoms as well as hypertension
- Also, more likely to be young (<40) with no family history of HTN
Key NICE guideline message for Hypertension
- Stepwise approach to treatment
- Treatment threshold
- Looking at overall CHD risk
- Differences with different ethnic groups
Issues with concordance with anti-hypertensive medication
• Most people with hypertension feel well
• Anti-hypertensives can make people feel unwell or give unwanted side-effects [e.g., erectile dysfunction]
• Treating because of long term risks of events - this can be a hard concept to explain to patients
Treatment for adults with hypertension without type 2 diabetes
Under 55
1. ACE inhibitor or ARB
2. calcium channel blocker of thiazide diuretic
If black African or African-Caribbean
1. calcium channel blocker
2. ACE inhibitor, ARB or thiazide diuretic
Anyone over 55
1. calcium channel blocker
2. ACE inhibitor, ARB or thiazide diuretic
- ACEI/ARB AND calcium channel blocker AND thiazide like diuretic
Monitor and review annually
Treatment for adults with T2 diabetes with hypertension
- step 1 is ACE inhibitor or ARB
- step 2 is calcium channel blocker or thiazide like diuretic
ACE inhibitors
Lisinopril, ramipril, imidapril
Angiotensin converting enzyme inhibitors
Relax veins and arteries and causes more water excretion
Prevent angiotensin converting enzyme in body from producing angiotensin II-substance which narrows blood vessels
Most common side effect is a dry cough
Contraindications for ace inhibitors
- Dont use on patients with angioedema, pregnant/breastfeeding women
- Use with caution in people of black african or caribbean origin, those with renal impairement, taking diuretics and some cardiomyopathies
ARBS
Candesartan, irbesartan, valsartan, losartan
Angiotensin receptor blockers
Reduce action of angiotensin II
Contraindications of ARBS
- Contraindicated in people with diabetes, pregnant women and those planning pregnancy, breastfeeding women
- Used with caution in people of black African or Caribbean origin, with renal impairment or renal artery stenosis or aortic/mitral valve stenosis, history of angioedema
Side effects- renal impairement, hyperkalaemia, angiodema, dizziness