Wk 13: Hypertension Flashcards
How is a patient treated if they have hypertension but no established CVD?
Primary prevention
Should a BP be taken manually or using a machine?
Pulse irregularity = manually
How do you measure blood pressure in people with symptoms of postural hypotension?
- Measure supine or seated
- Measure again standing for at least 1 min before measurement
What happens if the blood pressure measured in the clinic is 140/90 mmHG or higher?
- Retake 2nd during consultation
- If 2nd different from 1st take 3rd
- Record lower of last 2 as clinic BP
What happens if the blood pressure measured in the clinic is between 140/90 mmHG and 180/120mmHg?
Offer ABPM to confirm diagnosis of hypertension
What do you do if the person is unable to tolerate ABPM or is unsuitable?
Offer HBPM to confirm diagnosis of hypertension
What are readings of someone with blood pressure?
- Clinical 140/90 or higher
AND
- ABPM/HBPM daytime average 135/85 mmHg or higher
What happens if hypertension is not diagnosed?
- Measure clinic BP every 5 yrs
- If close to 140/90 - more frequent
What happens if an adult has type 2 diabetes without previously diagnosed hypertension or renal disease?
BP annually + lifestyle advice
What are the lifestyle advice given to people with suspected or diagnosed hypertension?
- Diet + exercise
- Red alcohol intake
- Red coffee + caffeine rich prods
- Low sodium intake
- Don’t offer calcium, magnesium or potassium to red BP
- Smoking cessation
What happens if a patient has severe hypertension (clinic BP 180/120 or higher) but no symptoms or same day referral?
Investigate target organ damage
- Identified: start antihypertensive immediatly w/o waiting results of ABPM/HBPM
- Not identified: repeat clinic BP w/in 7 days
When do you refer?
Clinical BP 180/120 + higher w/:
- Retinal haemorrhage or papilloedema
- New onset confusion
- Chest pain
- HF
- AKI
- Pheochromocytoma
What is offered to adults of any age with persistent stage 2 hypertension?
- Antihypertensives
- Lifestyle
What would you offer an adult aged under 60 with stage 1 hypertension and estimated 10 year risk below 10%?
Antihypertensive + lifestyle advice
What would you offer those aged over 80 with a clinic BP of >150/90?
Antihypertensive + lifestyle advice
What are the BP targets for Age <80 years?
- Clinic BP <140/90 mmHg
- ABPM/HBPM <135/85 mmHg
What are the BP targets for Age ≥80 years?
- Clinic BP <150/90 mmHg
- ABPM/HBPM <145/85 mmHg
What is the target BP for patients with CKD?
- Systolic below 140
- Diastolic below 90
What is the target BP for patients with CKD + diabetes, and ACR of > 70mg/mmol?
- Systolic below 130 (120-129)
- Diastolic below 80
What are the BP targets for type 1 diabetes?
135/85
What are the BP targets for type 1 diabetes w/ albuminuria or 2 features of metabolic syndrome?
130/80mmHg
What is given to people with hypertension + type 2 diabetes?
- ACE/ARB
- CCB or thiazide like diuretic
- ACE/ARB + CCB + Thiazide like diuretic
What is given to people age <55 + not caribbean or african origin?
- ACE/ARB
- CCB or thiazide like diuretic
- ACE/ARB + CCB + Thiazide like diuretic
What is given to > 55 or african origin?
- CCB
- ACE/ARB or thiazide like diuretic
- ACE/ARB + CCB + Thiazide like diuretic
What do you give if the potassium levels are <4.5mmol/l?
Low dose spironolactone
What do you give if the potassium levels are >4.5mmol/l?
Alpha blocker/betablocker