CASE STUDY 2: Hypertension and CVD Flashcards
What is the normal range for blood pressure readings?
120/80 mmHg
Anna has been recording her blood pressure whilst at home for 2 weeks. She find that her blood pressure is ranging between 141/84 mmHg and 156/91 mmHg.
She is 49 years old, Caribbean background and BMI is 32.4.
What blood pressure medication would you recommend ?
Anna is <55 years and black therefore:
A calcium channel inhibitor should be prescribed such ad Amlodipine
Why is a calcium channel inhibitor recommended for Afro-Caribbean people with hypertension rather than an ACEi ?
CCIs is the most effective class of drug used to reduce hypertension
Afro-Caribbean people are thought to have low levels of plasma renin. (Renin is an enzyme involved in the RAAS)
ACEi work by interfering with the body’s renin angiotensin aldosterone system (RAAS) which is…
Responsible for regulating blood pressure therefore ACEi will not be as effective
Is 75 mg of aspirin recommended for people trying to protect their heart?
No, aspirin should not be bought over the counter to ‘protect the heart’
What tool can be used to calculate a persons risk of having cardiovascular disease specifically risk of stroke ?
QRISK2 also used to calculate risk of having heart attack
Explain the different results patients can get in QRISK what that tells us about their cardiovascular risk?
LOW: If your score is less than 10% you have less than 1 in 10 chance of developing CVD
MODERATE: If you’re score is 10-20% you have between a 1 in 10 and 2 in 10 chance of developing CVD
HIGH: If your score is more than 20% you have a 2 in 10 chance of developing CVD
If a patient has a high QRISK score. What medication should we start them on to reduce the risk of CVD and why?
Satin to lower the cholesterol level. It’s
viewed as part of overall cardiovascular health risk.
Hypertension medication should also be given if QRISK is high
What lifestyle advice would you give to someone to reduce their risk of CVD ?
- Stop smoking
- Eat a healthy diet (watching salt intake to under 5g a day)
- Keep your weight and waist in check
- Exercise regularly
- Cut back on alcohol intake
What is hypertension and how does it arise ?
- Initial build up of plaque and thickening of the vessel wall
- This causes reformation and remodelling of the endothelium wall causing the narrowing of the lumen and build up of vascular pressure causing hypertension.
- Due to the narrowing blood that travels through the vessels travel at a higher pressure around the body
How would you diagnose hypertension ?
Taking ambulatory blood pressure readings
Blood pressure that ranges between 140/90 mmHg to 180/120mmhg is considered high BP.
What are the signs and symptoms of hypertension?
- Chest pain
- Headache
- Visual changes
What are the risk factors of high blood pressure ?
Obesity
high alcohol
metabolic syndrome
high sodium/salt intake
increase age
family history
diabetes
dyslipidaemia
Why should hypertension be treated ?
Reduce CV damage
Preserve renal function
Prevent IHD
Reduce mortality of strokes and MIs
What are the target blood pressure reading for patients with and without diabetes ?
SBP <140mmHg (<140-130mmHg in diabetes
DBP <90mmHg (<80mmHg in diabetes)
How is hypertension monitored ?
Monitor blood pressure using blood pressure machine regularly – training and advice on using home blood pressure monitors
