Lecture 2 - Hypertension Flashcards
How many adults in the UK have high blood pressure and how many aren’t currently receiving treatment?
Nearly 30% have high BP
And up to half receiving no treatment
How many people in the UK live with undiagnosed high blood pressure, without knowing they are at risk?
5-7 million people
How likely are people with high blood pressure to develop heart disease or have a stroke?
Three times more likely
What is hypertension a major risk factor for?
Ischaemic and haemorrhage stroke
MI
Heart failure
Chronic Kidney Disease
Conginitive Decline
Premature death
What is hypertension?
Raised blood pressure
What percentage of hypertension cases are primary?
95%
What percentage of hypertension cases are secondary?
<5% of cases
What are the signs and symptoms?
Some patients will not feel anything
Dizziness
Headache
Blurred/ Double Vision
SOB
Subconjunctival haemorrhage
Nausea
Nose bleeds
Drowsiness
Irregular heartbeats
How is hypertension diagnosed?
Measure BP in both arms:
- If the difference in readings between arms is more than 15mmHg repeat the measurements
- If the difference in readings between arms remains more than 15mmHg on the 2nd measurement - measure the subsequent blood pressure with the higher reading
If the blood pressure measured in clinic is above 140/90 mmHg what happens next..
Take the 2nd measurement during the consultation, is 2nd measurement subsequently different from the 1st take a 3rd measurement
Record the lower of the last 2 measurements as the clinic’s blood pressure
If the clinic BP is measured between 140/90 mmHg and 180/120 mmHg what happens next….
Offer ambulatory pressure monitoring (ABPM) or HBPM to confirm diagnosis of hypertension
should also carry out a CVD risk
Describe ABPM
At least two consecutive measurements are taken, at least 1 minute apart and wit the person seated and blood pressure is recorded twice daily, ideally in the morning and the evening
Blood pressure recording continues for at least 4 days, ideally for 7 days
Use the average values to confirm diagnosis of hypertension
Define stage 1 hypertension
Clinical BP ranging from 140/90 mmHg to 155/99 mmHg and subsequent ABPM daytime average
HBPM average blood pressure ranging from 135/85 mmHg to 149/94 mmHg
Define stage 2 hypertension
Clinic BP of 160/100 mmHg or higher but less than 180/120 mmHg and ABPM daytime average
HBPM average blood pressure from 150/95 mmHg or higher
Define stage 3 hypertension
Clinical systolic BP of 180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher
Name the lifestyle interventions which lower BP
Reduce alcohol intake, reduce weight loss, reduce salt intake and regular physical exercise
Name the lifestyle modifications which don’t reduce BP but reduce CV risk
Stopping smoking, reducing total intake of saturated fats, increase intake of oily fish
Name the pharmacological treatments of hypertension
Diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, Angiotensin II receptor antagonists, alpha1 antagonists, centrally acting anti-hypertensives
Give examples of ACEIs and ARBs
Ramipril, Lisinopril, Losartan, Candesartan
What do ACEIs and ARBs do?
Either prevent formations of or action of angiotensin II (potent vasoconstrictor)
Increase K+ by reducing aldosterone
When is ACEIs and ARBS first line for hypertension?
Patients < 55 yrs old
Diabetic patients due to renoprotective effects
What monitoring is required on ACEIs and ARBS?
Baseline U and Es - potassium levels particularly in patients taking other drugs which raise potassium levels - repeat 10-14 days then 3 months and with every dose increase and therefore annually after
What are the side effects of ACEIs and ARBs?
First dose hypotension
Persistent dry cough
Renal impairment - frequent U and E monitroing
Best to take at night
What do calcium channel blockers do?
Interfere with inward displacement of calcium ions through the channels into the cell membrane
Relaxation of vascular smooth muscle and causes vasodilation
Name the 3 types of CCBs
Dihydropyridines - amlodipine and felodipine - cause vasodilation of coronary and peripheral arteries with little effect on HR
Benzothiazipine - diltiazem - reduces HR
Phenylalkamines - verapamil - reduces HR
When are CCBs first line for hypertension?
Over 55 yrs old or black African or African Caribean family origin and not diabetic
not used in patients at risk of HF
What are the side effects of CCBs?
Headaches, abdominal pain, flushing, impotence, ankle oedema
Before increasing therapy what should you do?
Always consider adherence before increasing therapy, and always optimise the dose before adding in a second or third drug
Consider patient’s overall CVD risk
Involve patients in all decisions and explain the reasons
What is important when withdrawing therapy?
Hypotension - can result in falls and hospital admissions
Always enquire about any dizziness or light headedness, especially in elderly
Check for postural hypotension
Consider withdrawal if CV risk low and BP well controlled
What are the three options when treating patients with high blood pressure?
- Do nothing
- Pharmacological therapy
- Non-pharmacological therapy
When is the best time to take an anti-hypertensive?
Bedtime hypertension treatment improves CVD risk reduction
What do beta blockers do?
Reduce HR
Reduces renin CNS and PNS - reduces the release of neurotransmitters and sympathetic nervous activity
What are the side effects of beta-blockers?
Fatigue and lethargy
Bronchospasm, cold extremities
When are beta-blockers not used?
In diabetics and asthmatics
