Cardio Hypertension Flashcards
(32 cards)
what to do to diagnose hypertension
sitting and standing bp (wait one minutre between) in BOTH ARMS
If clinic blood pressure is between 140/90 mmHg and 180/120 mmHg, offer
ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension
If ABPM is unsuitable or the person is unable to tolerate it, offer
home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension
When using ABPM to confirm a diagnosis of hypertension, ensure that at least
2 measurements per hour are taken - Use the average value of at least 14 measurements taken during the person’s usual waking hours to confirm a diagnosis of hypertension
When using HBPM to confirm a diagnosis of hypertension, ensure that: (4 things)
- for each blood pressure recording, 2 consecutive measurements are taken, at least 1 minute apart and with the person seated and
- blood pressure is recorded twice daily, ideally in the morning and evening and
- blood pressure recording continues for at least 4 days, ideally for 7 days.
- Discard the measurements taken on the first day and use the average
clinic bp hypertension
140/90
abpm hbpm bp over
135/85
all patients with hypertenskion should have
a urinalysis to check for protein
hba1c and cholesterol
fundoscopy
12 lead ecg
stage 1 hypertension diagnosis
140/90 mmHg and 160/100 mmHg, and ambulatory daytime average or home blood pressure average of 135/85 mmHg or higher (or diastolic over 90)
stage 2 hypertension diagnosis
between 160/100 mmHg and 180/120 mmHg, and ambulatory daytime average or home blood pressure average of 150/95 mmHg or higher
severe hypertension diagnosis
clinic systolic blood pressure of 180 mmHg or higher, or a clinic diastolic blood pressure of 120 mmHg or higher
Refer patients for specialist assessment, carried out on the same day, if they have a clinic blood pressure of
180/120 mmHg and higher with signs of retinal haemorrhage or papilloedema (accelerated hypertension), or life-threatening symptoms for example new onset confusion, chest pain, signs of heart failure, or acute kidney injury
high blood pressure should be controlled before giving
aspirin
A target clinic blood pressure below …. mmHg is suggested for patients aged under 80 years; whilst a target clinic blood pressure below ….. mmHg is suggested for patients aged over 80 years.
140/90
150/90
For ambulatory or home blood pressure monitoring (during the patient’s waking hours), a target average of below ….. mmHg is suggested for patients aged under 80 years; whilst a target average of below …. mmHg is suggested for patients aged over 80 years
135/85
145/85
SIGN (2017) instead recommend a target clinic blood pressure below …. mmHg regardless of age, whilst patients with high cardiovascular risk and target organ damage should aim for a clinic blood pressure below …. mmHg.
140/90
135/85
If an angiotensin-converting enzyme (ACE) inhibitor is not tolerated, for example because of cough, offer
ARB
if African American consider
arb instead of ace
what is the step 1 treatment of hypertension
ace or arb
what is the step 2 treatment
add ccb or thiazide
offer thiazide if there is evidence of
heart failure
what is the step 3 treatment
ace/ arb + ccb + thiazide
what is the step 4 treatment
reassess with abpm or hbpm
refer to specialist
add alpha blocker or spironolactone
if under 55
ace
