Chapter 2 - Blood Pressure Conditions Flashcards Preview

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Flashcards in Chapter 2 - Blood Pressure Conditions Deck (85)
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1

What is hypertension?

Persistently raised arterial blood pressure

2

How is hypertension diagnosed?

Seated with the arm outstretched and support, and in a relaxed environment.

Over 140/90mmHg - take a second reading

Over 140/90mmHg again - offer ABPM or HBPM

Over 180/120mmHg - refer to specialist

3

What is ABPM and HBPM

ABPM - The BP is measured every half an hour for 24 hours and the average is taken

HBPM - The BP is measured twice a day for a minimum of 4 days (ideally 7 days)

4

How is hypertension classified?

Stage 1
Clinic BP 140/90-160/100mmHg
ABPM/HBPM 135/85-150/95

Stage 2
Clinic BP 160/100-180/20mmHg
ABPM/HBPM >150/95

Stage 3
Clinic BP
Systolic >180mmHg, diastolic >120mmHg

5

What are the blood pressure targets in <80 years and >80 years?

<80 - <140/90mmHg
>80 - <150/90mmHg

6

What are the blood pressure targets in diabetes?

Type 1 - <135/85mmHg
Type 2 - <140/90mmHg
Type 2 with renal disease, retinopathy or cerebrovascular disease <130/80

7

What are the blood pressure targets in renal disease?

<140/90mmHg

If there is coexisting diabetes, or if the ACR is >70, <130/80mmHg

8

What is the blood pressure target in pregnancy?

<135/85 mmHg

9

What are the lifestyle changes you would discuss in people with hypertension?

Lose weight
Increase exercise
Reduce alcohol consumption
Reduce dietary salt and saturated fat
Stop smoking
Reduce caffeine intake

10

How is stage 1 hypertension managed?

For all patients give lifestyle advice

Aged >80 - consider treatment is BP is >150/90mmHg

Aged 60-80 - consider treatment if patients have one of:
Target organ damage
Coexisting renal damage, diabetes or CVD
A 10-year CVD risk of over 10%

Aged 40-60 - consider treatment if there is a 10-year CVD risk of over 10%

Aged <40 - refer to specialist

11

How is stage 2 hypertension managed?

Give lifestyle advice
Start drug treatment

12

How is stage 3 hypertension managed?

If there are symptoms of retinal haemorrhage, papilledema, or life threatening symptoms e.g. chest pain, new onset confusion, AKI - same day referral to specialist

If these symptoms aren’t present assess target organ damage
Target organ damage present - start antihypertensives immediately
Target organ damage absent - do ABPM/HBPM

13

How is hypertension managed in <55 years or in any diabetic patients?

1. ACEi/ARB
2. ACEi/ARB + CCB/thiazide
3. ACEi/ARB + CCB + thiazide
4. Same as above. If potassium <4.5mmol/L spironolactone, if potassium >4.5mmol/L beta blocker or alpha blocker

14

How is hypertension managed in >55 years or in black African/Caribbean patients?

1. CCB
2. CCB + ACEi/ARB/thiazide
3. CCB + ACEi/ARB + thiazide
4. Same as above. If potassium <4.5mmol/L spironolactone, if potassium >4.5mmol/L beta blocker or alpha blocker

15

Is an ACEi or an ARB preferred in black African/Caribbean patients?

ARB

16

Why aren’t ACEi/ARBs first line in black African/Caribbean patients?

These patients have a greater likelihood of having a lower renin profile

17

When should you refer hypertension to a specialist?

BP uncontrolled despite an optimal dose of 4 drugs

Patients aged <40

Patients with retinal haemorrhage, papilledema, or life threatening symptoms e.g. new onset confusion, chest pain

18

In patients with heart failure and hypertension, would you offer a CCB or thiazide?

Thiazide like diuretic

CCBs can worsen HF, especially rate-limiting CCBs e.g. verapamil

19

What is gestational hypertension?

New-onset hypertension that develops 20 weeks after gestation

20

What is pre-eclampsia?

New-onset hypertension that develops 20 weeks after gestation and is damaged multiple organs e.g. liver and kidneys

21

Who is more at risk of pre-eclampsia and what should be done to prevent pre-eclampsia is these patients?

Women more at risk:
People with CKD, diabetes, autoimmune disease, chronic hypertension
Aged over 40
BMI over 35
10 year pregnancy interval
Multiple pregnancy
Family history of pre-eclampsia

Give aspirin 75mg OD from 12 weeks gestation (unlicensed)

22

What antihypertensives are given in pregnancy?

First line labetalol
Second line m/r nifedipine
Third line methyldopa

23

What is given for hypertension in breastfeeding mothers?

Black African/Caribbean patients - nifedipine or amlodipine

Others - enalapril

Monitor the babies BP and be aware of adverse reactions

24

What is hypertensive urgency and how is this managed?

This is severe hypertension without acute target organ damage

Use oral antihypertensives e.g. labetalol to reduce the BP over 24-48 hours

25

What is hypertensive emergency and how is this managed?

This is severe hypertension with acute target organ damage

Treat with IV antihypertensives e.g. hydralazine, labetalol, sodium nitroprusside, to reduce the BP by 20-25% in 2 hours

26

What are the problems associated with reducing the BP too quickly in hypertensive crisis?

Reduced organ perfusion, which can lead to blindness, MI, renal damage, cerebral infarction

27

What is phaeochromocytoma?

A rare and usually non-cancerous tumour of the adrenal gland.

It can result in hypertension, headaches, sweating and panic attack symptoms.

It usually requires surgery

28

What is pulmonary hypertension and what are the treatment options?

High blood pressure in the blood vessels that supply the lungs

Treatment options:
Epoprostenol
Iloprost
Sildenafil, tadafil
Selexipag
Ambrisentan...

29

What are the three types of drugs that affect the renin angiotensin system?

Can they be used together?

ACE Inhibitors
ARBS
Aliskiren

They are not recommended to be used together, as this increases the risk of hyperkalaemia, hypotension and renal impairment.

The use of aliskiren with an ACEI or ARB is contraindicated in patients with diabetes or an eGFR<60ml/min

30

How do ACE Inhibitors work?

Block the conversion of angiotensin I to angiotensin II