Hypertension (secondary or essential) Flashcards
Hypertension
Risk factors.
Lifestyle
- smoking
- alcohol
- diet
- weight
- exercise
Emotional
- anxiety
- stress
Social deprivation
- those from low income 30% more likely to have hypertension compared to those high income
Health
- chronic illness
- pregnancy
Hypertension
Causes of secondary hypertension.
renal disease
- glomerulonephritis
- renovascular disease
endocrine
- Cushing’s syndrome
- Conn’s syndrome
- phaeochromocytoma
pregnancy
iatrogenic
- corticosteroids
- oral contraception
- cocaine
Hypertension
How to diagnose stage 1 hypertension.
ABPM / HBPM
135/85-149/94
Hypertension
How to diagnose stage 2 hypertension.
ABPM / HBPM
150/95 +
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Hypertension
- lifestyle advise + ACEi/ARB/CCB
- if that doesn’t help consider double therapy, then triple
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How to calculate ABPM/HBPM.
- discount first day
- calculate averages of second readings
Hypertension
All patients with a new diagnosis of hypertension should have the following investigations:
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- 12 lead ecg
- urine dipstick
- HbA1c
- cholesterol
- U&Es
- fundoscopy
Hypertension
Why should a pt newly diagnosed with hypertension have an ecg?
assess cardiac function → detect left ventricular hypertrophy (LVH) → ?target organ damage
Hypertension
What would an ECG show with LVH?
tall R wave, deep S in V1 or V2, inverted T waves in V5 and V6, left axis deviation, QRS may be prolonged
Hypertension
What do we look for in a urine dipstick of a pt with newly diagnosed hypertension?
What would those findings imply?
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- Glucosuria – concurrent diabetes?
- Haemoturia – renal disease such as renal cell carcinoma? evidence of target organ damage?
- Proteinuria – renal disease as a secondary cause of hypertension? evidence of target organ damage?
Hypertension
What do we look for in the U&Es of a pt with newly diagnosed hypertension?
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- assess for chronic kidney disease which may indicate target organ damage.
- Assessing renal function will also guide medication options when discussing management.
Hypertension
Why do we do fundoscopy in pt with newly diagnosed hypertension?
presence of hypertensive retinopathy (target organ damage)
Hypertension
How do we grade the fundoscopy findings?
Grade 1
- silver wiring
Grade 2
- AV nipping (where artery crosses vein, vein gets thinner)
Grade 3
- flame haemorrhage
Grade 4
- papilloedema, cotton wool spots
- no disk visible
Hypertension
What are the BP targets:
- Age < 80 years
- Age ≥ 80 years
- People with frailty or multimorbidity
Age < 80 years
Clinic BP <140/90 mmHg or ABPM <135/85 mmHg
Age ≥ 80 years
Clinic BP <150/90 mmHg or ABPM <145/85 mmHg
People with frailty or multimorbidity
Use clinical judgement
Hypertension
Who should not be prescribed ACEi? (or we wary when prescribing?)
- pregnany women
- those with renal artery stenosis
Hypertension
What are some common side effects of ACEi?
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- cough
- hypotension
- hyperkalaemia
- renal injury
- foetal injury
- Urticaria
- Angioedema
Hypertension
What are some common side effects of CCB?
- Ankle oedema
- Constipation
- Palpitations
- Flushing
- Headaches
Hypertension
What are some common side effects of thiazides/thiazide-like diuretics?
- Hypokalemia
- Hyponatremia
- Metabolic alkalosis
- Hypercalcemia.
- Hyperglycemia
- Hyperuricemia.
Hypertension
Why are ACEi contraindicated in bilateral renal artery stenosis?
Hypertension
Explain the mechanism of ACEi and ARBs
Hypertension
Explain the mechanism of CCBs.
What is the drug target?
L-type calcium channel
Hypertension
Explain the mechanism of thiazide diuretics.
What is the drug target?
Sodium/chloride
cotransporter
Hypertension
Describe this fundoscopy.
normal fundus
Hypertension
What do we call this?
microaneurysms
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What do we call this?
dot and blot haemorrhages
Hypertension
What do we call this?
cotton wool spots
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What do we call this?
Pan-retinal photocoagulation
Hypertension
What do we call this?
AV nipping
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What do we call this appearance of a fundoscopy?
papilloedema
Hypertension
What is malignant hypertension?
a severely elevated blood pressure of ≥180/120mmHg with a new onset or progression of end-organ failure due to vascular damage.
