High BP Flashcards
Questions to ask in the history about the BP reading
What was the reading?
When was this measured?
How was this measured?
Where was this measured?
What were you doing just before the measurement?
Had you been sitting still for 5 minutes prior to the reading?
How were you feeling at the time?
Symptoms to ask about
Symptoms of high blood pressure - (red flags):
- Chest pain
- Headache
- Visual changes e.g. blurring of vision
- SOB
- Dizziness
- Nosebleeds
- Any symptoms of a rapid heartbeat, feeling anxious or tremor - possible phaeochromocytoma
Risk factors to ask about
Smoke or drink alcohol
Diet - salt and fatty food
Weight - BMI and any recent changes
Exercise - frequency, duration and type
Occupation - sedentary? or Stress at work?
Ethnicity
PMH questions
MI Stroke Angina DM Gout High cholesterol Kidney disease
FH questions
MI Stroke Angina Diabetes High cholesterol
SH questions
Anyone else at home?
Job - any stress? sedentary job
Alcohol and smoking
Diet and exercise
Examination and investigations
BP BMI Obs - HR and RR Qrisk score Fundoscopy (if signs of DM)
Investigations - ECG, lipid profile, U+E, HbA1c, blood glucose. Urine ACR.
24h BP monitoring if clinic BP is high
Explaining the diagnosis
Often it is not clear what the cause of HTN is
Rarely has symptoms but if left untreated it can increase the risk of heart attack and stroke
To confirm the diagnosis I would like to arrange a 24h BP monitor to measure your BP at regular intervals at home throughout the day and night.
This is to make sure the reading isn’t caused by stress of coming to the GP (White coat HTN)
Management of HTN (non-pharmaceutical)
There are some lifestyle changes that you can make to help lower your BP and reduce risk of heart attack and stroke, is this something you would be willing to try?
Smoking cessation - NHS stop smoking service
Alcohol - limit to 14 units a week with 2 alcohol free days
Diet - Reduce salt intake, DASH diet - high in fruit, vegetables and unsaturated fat, low in saturated fat and sugar.
Weight - advise what a healthy BMI is and signpost to weight loss groups
Exercise - aim for 30m moderate exercise 5 times a week (for example brisk walking or riding a bike)
Managing stress - e.g. mindfulness
Pharmaceutical management of HTN
Ramipril if <55 and not black
Amlodipine if >55 or if black
Statin
Discuss that may need to start these but will need the results of ABPM and Qrisk first
May need statin (Qrisk 10% or more and lifestyle modification is ineffective or inappropriate)
Stages of HTN
Stage 1 - 140-159/ 90-99
Stage 2 - 160 -179/ 100-109
Stage 3 - >180 / >110
Safety netting and follow up
If get severe chest pain and SOB then go to A&E
If get weakness of the limbs, slurred speech or facial drooping got to A&E
Follow up in 4w
Side effects of ramipril, amlodipine, statin
Ramipril - dry cough, headaches, dizziness
Amlodipine - swollen ankles, headaches, constipation
Statin - nausea, headache, muscle pain (tell doctor if get muscle pain as may need to reduce dose)
