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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- 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:
6
- 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?
2
- 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)
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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
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What are some common side effects of ACEi?
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- cough
- hypotension
- hyperkalaemia
- renal injury
- foetal injury
- Urticaria
- Angioedema
