1A Flashcards
(51 cards)
What are the types of hypertension
Essential
Isolated systolic
Secondary
Iatrogenic
Malignant/accelerated
What is essential hypertension?
blood pressure >140/90 mmHg with no secondary cause identified
What is the classification of HTN?
STAGE 1: 140/90 ABPM: 135/85
STAGE 2: 160/100 ABPM: 150/95
STAGE 3: systolic>180 diastolic>120
What is normal blood pressure?
<80 yrs: <140/90 ABPM: <135/85
>80 yrs: <150/90 ABPM: <145/90
Pathophysiology of HTN?
Increase in salt and water retention leads to volume overload
increased vascular resistance means pressure in vessels are high
BP= ?
BP= CO x TPR
longterm effects of high blood pressure?
end-organ damage
Risk factors of hypertension
Age
Salt intake
Genes/family history
Alcohol
Smoking- changes in vascular wall increases resistance
Obesity
Diabetes
Sign and symptoms of hypertension
Usually asymptomatic - has a family history of hypertension
If symptomatic: persistent headache or eye pain
Diagnosis of hypertension
3 BP readings and record lowest
eliminate white coat effect
Fundoscopy
BMI
Examine heart and lungs
ABPM for white coat effect
DDx of hypertension
Pheochromocytoma
Polycystic kidney disease
Obstructive uropathies
Investigations for Hypertension
Bloods: glucose, electrolytes, eGFR, Lipids, protein creatine ratio, Qrisk
CXR- cardiomegaly
ECG- left ventricular hypertrophy
Management of hypertension
Conservative: weight loss, salt reduction, smoking cessation, exercise
Drug treatment depending on stage/severity of hypertension
When should stage 2 hypertension be treated?
<80 yrs with:
end organ damage
diabetes, renal disease
Qrisk >10%
treat 2 of any age
Name drugs used to treat hypertension
Angiotensin-Converting Enzyme inhibitor
Angiotensin Receptor Blocker
Calcium Channel Blocker
Thiazide-like Diuretics
beta blocker
Step 1 treatment for Hypertension
ACE/ARB if: diabetic, <55 and not African or African Caribbean origin
CCB: all other groups (or cannot tolerate side effects fo ACE)
Step 2 treatment of HTN
1) add CCB or thiazide-like diuretics
2) add ACE, ARB or thiazide-like diuretics
Step 3 treatment of HTN
Combination treatment with ACE/ARB, CCB, and thiazide-like diuretic
Step 4 treatment of HTN
If K+ <4.5 mmol/l add spironolactone (K sparing diuretics)
If K+ >4.5 mmol/l add a higher dose thiazide-like diuretic or alpha or beta blocker
Name an ACEi
Ramipril, Lisinopril
Name an ARB
Losartan, candesartan
Name a CCB
Amlodopine
Name a thiazide-like diuretics
Indapamide
What are the two drugs used in step 4 hypertension?
if K+ <4.5 spironolactone
if K+ >4.5 add alpha/ beta blocker or higher dose of indapamide
