Lecture 2 Hypertension Flashcards
Secondary causes of hypertension (10-15%)
Diseases: CKD, Cushing’s syndrome, Obstructive sleep apnea, parathyroid disease, primary aldosteronism
Common medications: Amphetamines, Corticosteroids, Decongenstants, NSAID
Excessive food consumptions: Sodium, Ethanol, Licorice
Street Drugs and Other products: Cocaine, Methamphetamine, Anabolic Steroids, St.john’s wort
Who gets hypertension ???
Overweight
Physical inactivity
Tobacco use
Diabetes mellitus
Dyslipidemia
Proteinuria
Family hx of hypertension
Rationale for reduction of elevated BP
- CVD morbidity and mortality are directly related to the level of BP
- BP rises most in those whose BP is already high
- In humans, there is less vascular damage where BP is lower
- Antihypertensives therapy reduces CVD and death
Benefits of treating hypertension
Younger than 60: Reduces stroke, reduces risk of coronary event
Older than 60: Reduces overall mortality, cardiovascular mortality, incidence of stroke, coronary artery disease
Hierarachy for BP measurements
ABPM > HBPM> AOBM > OBPM
ABPM Preferred over HBPM due to :
Greater number of measurements per day
Improved adherence to measurement regimen
Daytime and nighttime values considered
ABPM daytime measurements and nighttime are how often
Daytime: 20 min
Nighttime: 30 min
What is the suggested protocol for home measurement of blood pressure
Two measurements Seperated by 1 minute
Morning and evening
For 7 days
First day should not be considered, following six days of blood pressure readings should be averaged
Advice for hypertensive patients: when to contact a healthcare professional based on home blood pressure readings
130- 179 S, 85-109 D: discuss with healthcare providers at next appointment
180-199S, 110-119D : schedule appointment with doctor
> 200 S, >120D: urgent appointment with doctor
Routine laboratory tests for patients with hypertension
Urinalysis: look for proteinuria
Blood chemistry: potassium, sodium, creatinine
Fasting glucose
Lipid profile: TC, HDL, LDL, Triglycerides
Standard 12-lead ECG
Pregnanacy for women of childbearing age
Who should be screened for secondary causes of hypertension
Severe or refractory hypertension ( defined as resistant to 3 or more drugs to maximum tolerated dose )
Acute rise in BP with previously stable BP
Proven age of onset before puberty
Age <30
Healthy behaviour recommendations for hypertension: Dietary
High in: fresh fruits, fresh vegetables, low fat dairy products, plant protein
Low in: saturated fat and cholesterol, sodium
Health behaviours management: Potassium intake
In patients not at risk of Hyperkalemia, increased dietary potassium intake to reduce blood pressure
- as this leads to a decrease in BP
Effect most consistently seen in patients with HTN
