Hypertension, Chronic Kidney Disease and Hyperlipidaemia in Primary Care Flashcards
What is Chronic Kidney Disease?
A reduction in kidney function or structural damage (or both) present for more than 3 months, with associated health implications.
What is Hypertension?
Persistently raised arterial blood pressure.
What are the diagnostic criteria for chronic kidney disease? What are the parameters for the stages?
Measured by GFR.
Stage 1 >90
Stage 2 60-89
Stage 3a 45-59
Stage 3b 30-44
Stage 4 15-29
Stage 5 <15
What are the diagnostic criteria for the stages of hypertension?
Stage 1
Clinical reading: 140/90 - 159/99
ABPM or HBPM average: over 135/85
Stage 2
Clinical reading: 160/100 (less than 180/120)
ABPM or HBPM average: over 150/95
Stage 3 (severe)
Clinical reading: Over 180 (systolic) or 120 (diastolic).
What is hyperlipidaemia?
Persistently high levels of lipids in the blood.
What is the QRISK score and what is the significance of it being raised?
QRISK is a score that calculates whether you have a low, moderate or high risk of developing CVD in the next 10 years.
If you have a high QRISK score this means that you have at least a two in ten chance of having a stroke or heart attack in the next 10 years.
How might a person with chronic kidney disease present to the GP? (symptoms)
Lethargy
Itch
Breathlessness
Cramps (often worse at night)
Bone pain
Loss of appetite
Polyuria (tubular concentrating ability is impaired)
Oliguria
Nocturia (due to impaired solute diuresis or oedema)
Anuria (due to possible acute kidney injury [AKI], obstructive uropathy causing urinary retention; or end-stage renal disease).
What may be the findings on examination of a patient with CKD?
Uraemic odour
Pallor
Cachexia and signs of malnutrition.
Cognitive impairment
Dehydration or hypovolaemia
Tachypnoea
Hypertension
Palpable bilateral flank masses with possible hepatomegaly
Palpable distended bladder.
Peripheral oedema.
Peripheral neuropathy or myopathy.
Frothy urine (may indicate proteinuria).
How might a patient with hypertension present to the GP?
Often asymptomatic.
If severe hypertension can present with symptoms of:
- headaches
- visual disturbances
- nosebleeds
- shortness of breath
What signs may be seen in patients with hyperlipidaemia?
Tendon xanthomas
Corneal arcus
Xanthelasma(s)
When should a diagnosis of familial hypercholesterolaemia be considered?
Total cholesterol is greater than 7.5mmol/L and or there is a personal or family history of premature CHD.
What are some of the causes of secondary hyperlipidemia?
nephrotic syndrome
hypothyroidism
biliary obstruction
pregnancy
myeloma
porphyria
steroids
obesity
diabetes mellitus
renal failure
excess ethanol intake
beta-blockers
thiazide diuretics
oral contraceptive pill
glycogen storage disease
When should a patient with hypertension be referred to a same-day specialist?
A clinic blood pressure of 180/120 mmHg and higher with:
Signs of retinal haemorrhage and/or papilloedema (accelerated hypertension), or
Life-threatening symptoms, such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury.
Suspected phaeochromocytoma, for example labile or postural hypotension, headache, palpitations, pallor, abdominal pain, or diaphoresis.
What screening/monitoring must a patient with diagnosed hypertension have annually?
Blood pressure check
Renal function assessment
What are the important lifestyle changes for a patient with hypertension?
Diet and exercise
Caffeine
Dietary sodium
Smoking
Alcohol
What are the important lifestyle changes for a patient with CKD?
Stopping smoking if appropriate.
Drinking alcohol in moderation.
Maintaining a healthy body weight.
Eating a healthy diet and taking regular exercise.
A low-protein diet (dietary protein intake of less than 0.6–0.8/kg/day) is not routinely recommended.
Specialist dietary advice about potassium, phosphate, calorie, and salt intake may be arranged by the person’s specialist for people with end-stage CKD following referral.
What are the three first-line medications for the treatment of hypertension?
ACEi
ARB
CCB
When would an ACEi/ARB be offered first-line to a patient with hypertension?
Hypertension + diabetes
No hypertension, <55 years and not Afro-Caribbean.
What are the second-line options for the treatment of hypertension?
ACEi
ARB
CCB
Thiazide-like diuretic
When would a patient be offered an ACEi/ARB or a thiazide-like diuretic as a second-line treatment for their hypertension?
If they had been started on a CCB.
When would a patient be offered a CCB or a thiazide-like diuretic as a second-line treatment for their hypertension?
If they had been started on an ACEi/ARB.
What is the third-line treatment for hypertension?
Add one of the drugs that has not yet been tried.
What are the treatment options for resistant hypertension and what is this dependent on?
Spironolactone
Beta-Blocker
Alpha-Blocker
Patient’s potassium levels.
When can a patient with resistant hypertension be started on spironolactone?
If their potassium levels are lower than 4.5mmol
