blood pressure and hypertension Flashcards
(35 cards)
what is blood pressure:
The pressure of blood againstthe walls of the main arteries
when is pressure highest
during systole when the heart is contracting (systolic BP)
when is it lowest
during diastole when the heart is relaxing (diastolic BP)
With regard to the clinic measurement of blood pressure, what is the lower limit reading for diagnosis of Stage 2 Hypertension?
150/95 mmHg
what is hypertension:
“When the BP is elevated to an extent that clinical benefit is obtained from blood pressure lowering”
upper end of normal blood pressure is often accepted as
140/90 mmHg
how is blood pressure distributed (data) and how is this key?
normally distributed in the population
- This means there is no natural cut-off point above which ‘hypertension’ definitively exists and below which it does not
Possible causes of hypertension include:
- Renal disease
- Endocrine causes
- Vascular causes
- Drugs e.g. sympathomimetics, oestrogens
- Lifestyle
– Excess weight
– Smoking
– Alcohol, caffeine and dietary salt intake
– Saturated fat intake
– Lack of exercise
Drug Use Process (DUP) Indicators (same as last time) (The steps involved in delivering Pharmaceutical Care)
- Need for a drug- indication?
- Select drug- which is most appropriate drug for
- Patient
- Cost effectiveness
Select regimen- which is most appropriate for
- Patient
- Cost effectiveness
- Minimise toxicity
1. Provide drug- supply in a timely manner
2. Drug administration- ensuring appropriate devices and techniques used
- Monitor drug therapy- for effectiveness and adverse effects
- Counsel patient and educate to ensure proper use of medicines
7.Evaluate effectiveness of a patients drug therapy
How is hypertension diagnosed in the UK?
Measure Blood Pressure in both arms
If clinic blood pressure is 140/90 mmHg or higher?
repeat
if clinic blood pressure is 140/90 mmHg and 180/120 mmHg?
offer ABPM (or HBPM if ABPM not tolerated or suitable) to confirm diagnosis
Ambulatory blood pressure monitoring (ABPM)
- what happens in this
- Records a day time average
- Patient wears a BP machine
- BP is automatically measured at repeated intervals throughout the day and night, while they continue routine activities
ABPM how many readings per hour
Ideally 2 readings per hour during waking hours
Home blood pressure monitoring (HBPM)
- when do we use this
- If ABPM not suitable
how often do we record blood pressure in HBPM
Record twice each day- morning and evening
how many readings per recording in HBPM
For each recording, should take two consecutive readings, at least 1 min. apart
for how many days do we record in HBPM
- A minimum of 4 days, ideally 7 at home
- Discard day 1’s results, use an average from remaining results
treating hypertension
- what is the q risk
tool used to calculate cardiovascular risk
why should we treat hypertension? what can it lead to?
stroke, retinopathy, vascular disease, malignant hypertension, renal impairment, heart issues like myocardial infarction or angina
treatment of hypertension:
- what do we prescribe at step one?
Patients already taking bendroflumethiazide or hydrochlorothiazide and who are stable and blood pressure controlled, should continue on diuretics
if then doesn’t control it, what do we give
If Calcium Channel Blocker not suitable for step 2 offer a thiazide-type diuretic, first line are indapamide and chlortalidone are first line
For patients of black African or Caribbean family origin, consider an ARB in preference to
ACEi in combination with the CCB
Blood pressure that remains 140/90 mmHg or higher after Step 3 treatment with optimal or best tolerated doses should be considered as
resistant hypertension
* In these cases, consider step 4 treatment or seeking expert advice
