Condition- Hypertension Flashcards
What is hypertension
Systolic > 140 mm Hg and/or diastolic > 90 mm Hg measured on three separate occasions with no secondary cause identified
What are the two main classifications of hypertension (according to aetiology) which type of HT is more common?
- Primary (essential) hypertension
- idiopathic so no know cause
- Most COMMON (90%)
- Secondary
- Isolated systolic Hypertension- stiffening of large arteries
- Malignant hypertension- rapid rise in BP causing vasuclar damage
Give some examples of causes of secondary hypertension (go through systems)
RENAL:
- renal artery stenosis
- chronic glomerulonephritis
- chornic pyelonephritis
- Chronic renal failure
- Renovascular disease
ENDO:
- DM
- Hyperthyroidism
- Cushings
- Conns
- HPT
- Phaeochromocytoma
- Congenital adrenal hyperplasia
- Acromegaly
CVS:
- aortic coarction
- Increase intravascular volume
What is isolated systolic hypertension?
Caused by stiffening of the large arteries (arteriosclerosis)
Most common form in the UK – affects >50% of the over 60s
Which syndrome in pregnant women can cause HT?
Pre-eclampsia
List some drugs that could cause HT
Sympathomimetics
Corticosteroids
COCP
List some symptoms that hypertensive patients may present with.
Usually ASYMPTOMATIC
- Symptoms of complications: retinopathy, nephropathy, IHD, HF, PVD
- Symptoms of cause
- Scotomas: visual field loss
- Blurred vision
- Headaches
- Seizures
- SOB- if congestive HF
- Chest pain
What are the three objectives when managing a patient with Hypertension?
- Look for risk factors
- Identify cause of HT
- Target organ damage
What is the criteria for concluding that a patient has hypertension?
- Blood pressure measured if >140/90mmHg measure a further two times and take lower of last two
- If BP>140/90mmHg offer ABPM or HBPM
- If BP > 180/110mmHg start immediately on Tx, check for end organ damage and refer to phaeo specialist if suspected (6Ps)
What signs on physical examintion of a patient could give you an idea about the cause of the hypertension…
- CVS: Radiofemoral delay = coarctation of the aorta distal to the left subclavian artery
- RENAL: Renal artery bruit = renal artery stenosis,Palpable kidneys
- ENDO: Signs of phaeochromocytoma or Cushing’s
List how you would asses target organ damage?
- CVS: ECG to see signs of LV hypertrophy, might hear S4
- RENAL: urine dip (proteinuria, haematouria), U&Es and eGFR
- EYES: Retinal fundoscopy
HARDER: What grading system is used to grade the extent of hypertensive retinopathy. And go through the characteristics of each grade…
Keith Wagner Classification
- Grade I: Silver wiring (silver line down the middle of arterioles)
- Grade II: Silver wiring + AV nipping (artery crosses the vein and nips it as it crosses, causing vein to become narrow due to high pressure in artery)
- Grade III: Flame haemorrhage, sometimes cotton wool spots too
- Grade IV: papilloedema (cannot see optic disc) – these can be either due to chronic hypertension or intracranial hypertension (caused by a brain tumour), requires admission
Which investigations would you order for someone with hypertension?
Aims: Assess risk factors, aetiology and target organ damage
- Bloods: U+Es, glucose, lipid profile, renin, aldosterone, catecholamines, K+ (low in Conn’s), Ca2+ (High in HPT)
- Urine Dipstick: protein and blood
- ECG: LV hypertrophy or ischaemia
- ABPM: to exclude white coat hypertension
What advice could you give to a patient with hypertension?
- smoking cessation
- Lose weight
- reduce alcohol intake
- reduce dietary sodium
When would you give ACEi or ARB as first line treatment for hypertension?
- If SBP>160 or DBP > 100 or evidence of end-organ damage. Medical treatment is recommended
- ACEi or ARB if:
- <55yrs
- Diabetic
- HF
- LV dysfunction
