L13: Hypertension Flashcards
What is hypertension classified into
Primary
Secondary
What is primary hypertension
Has no identifable single cause
What is secondary hypertension
Has a known underlying cause of hypertension
What factors other than BP increase cardiovascular risk
Male sex Age Smoking Dylipidemia Obesity Family history Cholesterol
What are the causes that cause secondary hypertension
Renal disease
Vascular disorders
Endocrine disorders
Drugs
What is an endocrine disorder that can cause hypertension
Primary hyperaldosteronism
How does primayr hyperaldosteronism cause hypertension
High levels of aldosterone act on the kidney to cause sodium retention which causes water retention and volume expansion causing hypertension
What is an ambulatory blood pressure monitoring for
If the patient has a raised blood pressure in clinic you can measure their bp for 24 hours, which then the average bp is calculated
What are the uses of abpm for
To diagnose hypertension To diagnose white coat syndrome Suspected of masked hypertension Suspectd hypotension Suspectd pre-eclampsia
What is stage1 hypertension defined as
Clinic blood pressure as: greater or equal to 140/90 or 135/85 in ABPM
What happens when the systolic and diastolic pressur fall into different catergories
We take the highest pressure to determine the stage
What is white coat syndrome
when the patient has a high blood pressure in clinic but a nromal ABPM
What is the aim for treating hypertension
Lower the blood pressure to reduce the risk of end organ damage, CVD, clinical events, mortality.
What is the the target blood pressure we aim for people under 80years old
Less than 140/90
What is the target of blood pressure we aim for people ages 80 years or older
Less than 150/90
What is a conervative management of hypertension
Lifestyle advice:
- moderate alcohol
- reduce salt
- stop smoking
- exercise
- weight reduction
- reduce stress
To reduce the risk of cvd in patients with hypertension what can we do
prescibe statins- reduce cholsterol
Antiplatelet therapy- for stroke and chronic artery disease
Treat diabetes
Treat heartfailire- beta blockers, RAAS, and sprinolactone
Which approach is used to presciribe antihyeprtensive drusg
Step wise approach
What are the 2 categories of people in the stepwise apprach
Younger than 55
55 years older or black patients at any age
What is the first line management of younger patients of less than 55
Ace inhibitor
What is the first line treatmetn for patients older than 55 and blakc
Calcium channle blockers or diuretics
What is the second line treatmetn in patients
Ace inhibitor and calcium channel blocker
Or
Ace inhibitor and diuretics
What is the third line treatmetn
Ace inhibitor
Calcium channel blocker
Diuretics
What is the 4th line treatment
Add: Diuretics Alpha blcoker Beta blocker Consider seeking specialiast advice
If ace inhibitors are not tolerated what can we use
Arbs
If calicum channel blockers are not tolerated whst can we use
Diuretics
