mica week 7 Flashcards
What are modifiable risk factors for cardiovascular disease
age
male
ethnicity
familial hypercholesterlaemia
What aremodifieable risk factors
diet
smoking
exercise
diabetes
hypertension
obesity
What are causes for primary hypertension
What are causes for secondary hypertension
secondary
renal diabetic nephropathy, PKD, glomerulonephritis
vascular, renal artery stenosis, coarctation of aorta
endocrine: conns, phaechromocytoma and cushing
drugs: alcohol, ampethamies, coccain, ciclosporin, COCP, corticosteroids
other connective tissue disorders such as
What percentage of hypertension is secondary
10
What are the different stages of hypertension?
Stage 1: 135/85-149/94mmhg
Stage 2: over 150/95
Stage 3: over 180/120
How do you treat hypertension
under 55
1st ACE or ARB
2nd ACE or ARB + CCB or thiazide
3rd Thiaze+ CCB+ ARB or ACE
over 55
1stCCB
2nd CCB+ ACE or ARB or thiazide
3rd Thiaze+ CCB+ ARB or ACE
How do you treat someone with stage 2 hypertension
drug treatment
how do you treat someone with stage 1 hypertension
stage 1
if over 80 higher threshold (150/90)
look for end organ damage (proetinuria, fonduscopy)
higher Q risk than 10%- drugs
Q risk lower than 10% and under 60 - talk to patient conservative is ok
Age under 40 look for secondary
someone has diabetes and hypertension
how would you treat him
ramipril
what is the life style advice to give to a hypetensive patient
stop smoking
reduce sodium intake
reduce caffein rich products
reduce alcohol
encourage exercise and healthy diet
63 year old male has stage 2 hypertneisonand no other PMH. What is his clinic BP target?
in clinic - 140/90
What are the targets for BP?
BP
less than 80 years old
140/90 in clinic
135/85 at home
over 80
150/100 in clinic
145/95 at home
What is the target blood pressure in diabetics?
same as the others
140/90 in clinic
135/85 at home
BUT with CKD
clinic 130/80
at home 125/75 (or ambulatory)
What do you do on an annual review in GP
checking compliance
Checking BP
checking renal function
- U &E,Cr,e GFR
- urine dipstick for protein
Asses Q risk
What is accelerated Hypertension?
180/120
Have to have signs of hypertension such as retinal haemorrhage and or paillooedema and end organ damage
Aetiology- causes are secondary hypertension (pre- eclapmsia, scleroderma or drugs such as coccaine)
how do people with accelerated hypertension present
asymptomatic
headache
seizure vomitting
How do you treat accelerated hypertension
- IV antihypertensive (sodium nitropusside, labetalol, GTN) aim to reduce over 24-48hours
- close monitoring- bloods ech and CT head
- investigation of underlying causes
How do you differentiate between stage 3 and malignant hypertension?
malignant - symptomatic and end organ damage
What do you use for the target cardiovascular risk with lipid modifying treatment
Look at non HDL cholesterol
what is the aetiology of hyperlipidaemia
genetic -
obesity
hypothyrodism
diabtes
nephrotic
renal
alcohol
who do you treat for lipid modification
primary:
look at Qrisk - over 10% - give medication
consider for all patient with high rik groups: over 85,CKD, T1DM
secondary prevention
all patients with established CVD advised to start a high intensity statin regardless of Qrisk
What is part of the Qrsik ?
- age
- sex
- CKD
- hypertension
- diabetes
- smoking
What is the lifestyle advice for hyperlipaemia
- increase fish, fruit and vegetable, fibre, unsalted nuts,seeds, legumes
- reduced: sugar, saturates fats, salt
- stop smoking
- weight loss
- regular exercise
- encourage reduction of alcohol intake
how do you treat hyperlipaediamia
Atorvastatin
or simvastatin or rosuvastatin
