CCC - HTN Flashcards
When should you investigate for secondary causes of hypertension and what are these?
(the categories and examples (4))
Age less than 40
1) Renal disease - glomerulonephritis, chronic pyelonephritis
2) Endocrine disease - hyperaldosteronism, Cushings, phaeochromocytoma, hyperpaprathyroidism
3) Pregnancy
4) Drugs
What are the symptoms of a phaechromacytoms?
episodic feelings as if about to die, headaches, PAROXYSMAL sweats/palpitations
What symptoms of complications do you need to ask for in HTN? (3)
Angina
Intermittent claudication
Visual changes
(good to ask about risk factors also)
In HTN what are the stages and their values? (3)
Stage 1 - 140/90 (ABPM/HBPM - 135/85)
Stage 2 - 160/100 (ABPM/HBPM 150/95)
Stage 3 - Systolic over 180 or diastolic of over 110
While waiting for confirmation of HTN diagnosis what investigations should you carry out for target organ damage?
BUFE
Bloods - FBC, U&E, creatinine, eGFR, TC/HDL
Urine - dipstick and ACR calculation
Fundoscopy - hypertenive retinopathy
ECG - LVH or signs of CHD
What are the specific investigations for secondary cause of HTN? (5)
Phaeochromacytoma - 24h metinephrines
Cushings - urinary free cortisol and dexamthethasone supression test
Hyperaldosteronism - renin/aldosterone levels
Hyperparathyrodism - calcium level
Renal artery stenosis - MRI of renal arteies
How does the QRISK2 caclulation influence the management of HTN?
1) QRISK2 greater than 10 % = start a statin
2) QRISK2 greater than 20% = high risk thus treat HTN
When do you treat people if they are stage 1 HTN?
1) Target organ damage
2) Established CVD
3) Renal disease
4) diabetes
5) QRISK2 of greater than 20%
6) Over 80
What is the treatment ladder for HTN?
Less than 55 - ACEi, ACEi + CCB, ACEi + CCB + Thiazide like diuretic
Over 55/black/African/Carribean - CCB, CCB + ACEi, ACEi + CCB + Thiazide like diuretic
What are treatment aims for HTN in normal, diabteic, frail people?
Normal - 140/90
Diabetic - 130/80
Frail - 150/90
When should you follow up HTN?
Annually (?earlier if changing treatment)
What anti HTN drug should you use in diabetics?
ACEi (even if over 55 or black)
In HTN patients how often shuld you check renal function?
Annually - if find proteinuria need to send sample to calculate ACR - worried about CKD
How does ambulatory blood pressure monitoring work?
24 hr recording
Two every hour
Need at least 14 measurements
How does home blood pressure monitoring work?
Twice a day (morning and evening)
For 1 week
(sometimes easier to let them have it for a month)
Discard the first ay reading - nerves
