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GP > Hypertension, Chronic Kidney Disease and Hyperlipidaemia in Primary Care > Flashcards

Hypertension, Chronic Kidney Disease and Hyperlipidaemia in Primary Care Flashcards

1
Q

What is Chronic Kidney Disease?

A

A reduction in kidney function or structural damage (or both) present for more than 3 months, with associated health implications.

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2
Q

What is Hypertension?

A

Persistently raised arterial blood pressure.

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3
Q

What are the diagnostic criteria for chronic kidney disease? What are the parameters for the stages?

A

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

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4
Q

What are the diagnostic criteria for the stages of hypertension?

A

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).

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5
Q

What is hyperlipidaemia?

A

Persistently high levels of lipids in the blood.

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6
Q

What is the QRISK score and what is the significance of it being raised?

A

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.

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7
Q

How might a person with chronic kidney disease present to the GP? (symptoms)

A

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).

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8
Q

What may be the findings on examination of a patient with CKD?

A

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).

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9
Q

How might a patient with hypertension present to the GP?

A

Often asymptomatic.
If severe hypertension can present with symptoms of:
- headaches
- visual disturbances
- nosebleeds
- shortness of breath

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10
Q

What signs may be seen in patients with hyperlipidaemia?

A

Tendon xanthomas
Corneal arcus
Xanthelasma(s)

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11
Q

When should a diagnosis of familial hypercholesterolaemia be considered?

A

Total cholesterol is greater than 7.5mmol/L and or there is a personal or family history of premature CHD.

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12
Q

What are some of the causes of secondary hyperlipidemia?

A

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

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13
Q

When should a patient with hypertension be referred to a same-day specialist?

A

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.

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14
Q

What screening/monitoring must a patient with diagnosed hypertension have annually?

A

Blood pressure check
Renal function assessment

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15
Q

What are the important lifestyle changes for a patient with hypertension?

A

Diet and exercise
Caffeine
Dietary sodium
Smoking
Alcohol

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16
Q

What are the important lifestyle changes for a patient with CKD?

A

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.

17
Q

What are the three first-line medications for the treatment of hypertension?

A

ACEi
ARB
CCB

18
Q

When would an ACEi/ARB be offered first-line to a patient with hypertension?

A

Hypertension + diabetes
No hypertension, <55 years and not Afro-Caribbean.

19
Q

What are the second-line options for the treatment of hypertension?

A

ACEi
ARB
CCB
Thiazide-like diuretic

20
Q

When would a patient be offered an ACEi/ARB or a thiazide-like diuretic as a second-line treatment for their hypertension?

A

If they had been started on a CCB.

21
Q

When would a patient be offered a CCB or a thiazide-like diuretic as a second-line treatment for their hypertension?

A

If they had been started on an ACEi/ARB.

22
Q

What is the third-line treatment for hypertension?

A

Add one of the drugs that has not yet been tried.

23
Q

What are the treatment options for resistant hypertension and what is this dependent on?

A

Spironolactone
Beta-Blocker
Alpha-Blocker
Patient’s potassium levels.

24
Q

When can a patient with resistant hypertension be started on spironolactone?

A

If their potassium levels are lower than 4.5mmol

25
Q

When would a beta-blocker be contraindicated in a patient with hypertension?

A

If they had asthma and were taking a beta agonist.

26
Q

What are the medication options for a patient with CKD?

A

Hypertension -> antihypertensives
Lipid-lowering therapy -> statins
Antiplatelet therapy
Consider Dapagliflozin

27
Q

What drugs are used for lipid modification?

A

Statins

28
Q

What clinical assessment and blood tests should be done before commencing statin therapy?

A

Alcohol consumption.
Blood pressure.
Body mass index.
Smoking status.

Exclude possible secondary causes of dyslipidaemia.

Lipid measurement — at least one lipid sample should be taken to measure a full lipid profile. This should include measurement of total cholesterol, high-density lipoprotein cholesterol (HDL-C) cholesterol, non-HDL-C (the difference between total and HDL-C), and triglycerides.

Patient should be asked whether they have experienced any generalised muscle aches before, if so do CK.

LFTs
Renal function
HbA1c

29
Q

What follow-up is needed for patients that have been started on statin therapy and at what intervals?

A

Measure total cholesterol, high-density lipoprotein cholesterol (HDL-C), and non-HDL cholesterol (total cholesterol minus HDL-C) levels in all people after 3 months of statin treatment.

Recheck liver function tests (LFTs) within 3 months of starting treatment, and again at 12 months.

Review statin treatment annually.

30
Q

When should patients be offered lipid modification?

A

Offer lipid modification therapy to people aged 84 years and younger if their estimated 10-year risk of developing cardiovascular disease (CVD) using the QRISK assessment tool is 10% or more and lifestyle modification is ineffective or inappropriate.

31
Q

What patients can be offered lipid modification treatment without formal assessment?

A

Type 1 diabetes who:
Are aged more than 40 years.
Have had diabetes for more than 10 years or have established nephropathy.
Have other CVD risk factors.

Chronic kidney disease

Familial hypercholesterolaemia

32
Q

What primary prevention is recommended in all patients over 85?

A

High-intensity statin
Atorvastatin 20mg
Weighing up all the risks and benefits.

33
Q

What first-line statin treatment is generally recommended for primary prevention?

A

Atorvastatin 20mg

34
Q

What first-line statin treatment is generally recommended for secondary prevention?

A

Atorvastatin 80mg

GP (14 decks)

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