Data interpretation: Hypertension & blood pressure readings Flashcards
(63 cards)
What are the 3 stages of hypertension?
Stage 1 hypertension
Stage 2 hypertension
Stage 3 hypertension
To diagnose hypertension, what are the 2 ways in which a patient must measure their blood pressure?
Clinic blood pressure: Their blood pressure is measured by a nurse or doctor during an appointment
AND ——————————————————
Ambulatory blood pressure monitoring: Patient measures blood pressure throughout the day and night, during normal activities, using a portable device
OR
Home blood pressure monitoring: Patient measures blood pressure at home over a period of days or weeks, usually at specific times, while seated and resting
How do you explain to a patient what hypertension is?
Blood pressure is the force of your blood pushing against the artery walls, which are the tubes in the body that transport blood
If the blood pressure is too high, this is called hypertension
How do you explain to a patient what the 2 main types of hypertension are?
The 2 types are essential hypertension and secondary hypertension
Essential hypertension is when your high blood pressure isn’t due to any identifiable cause
Secondary hypertension is when your high blood pressure has occurred as a result of another condition
How would you explain to a patient what the risk factors are for essential hypertension?
There are some major risk factors that can lead to essential hypertension:
Increasing age
Lack of exercise
Smoking
Unhealthy diet with lots of salt
Obesity
High alcohol intake
Genetics, if other family members also have high blood pressure
How would you explain to a patient what the causes are for secondary hypertension?
RRENALSS
There are several conditions that can cause high blood pressure, for example:
R: Renal conditions such as glomerulonephritis, renal artery stenosis
R: RBCs: Polycythemia
E: Endocrine/hormonal conditions such as Cushing’s syndrome, Conn’s syndrome, pheocromocytoma, diabetes AND drugs that affect hormone levels such as OCP, NSAIDs, alcohol, steroids
N: Conditions originating from the nervous system eg. Raised intracranial pressure
A: Aortic coarctation (narrowed aorta)
L: little people: Pregnancy-induced high BP
S: Stress eg. Trauma, white-coat hypertension
S: Sleep apnea
How do you explain to a patient how their clinic BP is measured?
A doctor or nurse will measure their blood pressure manually using an arm cuff
- If the first BP reading suggests hypertension, they will take a second BP reading to confirm
- If the second BP reading is quite different from the 1st, then they will take a 3rd reading and use the lowest of the 2nd and 3rd readings
- They will measure the BP in both arms, and if there is more than a 15 mmHg difference the doctor will measure both arms again. Highest BP arm is used for diagnosis
How do you explain to patient why ABPM or HBPM is also needed to diagnose hypertension?
Some people can get white-coat syndrome during their appointment to measure BP: Being in a medical setting makes you anxious, which will increase your blood pressure
For ABPM or HBPM, it is measured at home by the patient themselves or by an automatic monitor, so the readings will not be affected by white-coat syndrome
How do you explain to a patient how ABPM is measured?
- ABPM comes with arm cuff and monitor, which the patient needs to wear for 24 hours (the monitor is on a belt)
- ABPM will take daytime readings every 30 minutes and nighttime readings every 60 minutes
- ABPM will make a sound before it takes a reading: Make sure you are sitting with legs uncrossed/standing supported then keep arm below heart level. Don’t talk or move during measurement
- Avoid showers and baths during 24 hours period so that ABPM doesn’t get wet
- Driving not recommended
How do you explain to a patient how HBPM is measured?
- Take 2 readings each one minute apart. Do this in the morning before breakfast and repeat process in the evening before bed: Overall should take 4 readings in one day
- Continue so that you have readings for at least 4 days, ideally 7 days
- Make sure you are sitting with legs uncrossed, arm at heart level, don’t talk or move
What 2 criteria must be fulfilled to diagnose stage 1 hypertension?
Clinic BP from 140/90 to 159/99 mmHg
ABPM/HBPM from 135/85 to 150/95 mmHg
What 2 criteria must be fulfilled to diagnose stage 2 hypertension?
Clinic BP from 160/100 to 180/120 mmHg
ABPM/HBPM is 150/95 mmHg or higher
What 2 criteria must be fulfilled to diagnose stage 3 hypertension?
Clinic systolic BP higher than 180 mmHg
Clinic diastolic BP higher than 120 mmHg
How do you work out the blood pressure from ABPM readings?
Use the average value of at least 14 measurements taken during the person’s usual waking hours to confirm a diagnosis of hypertension
How do you work out the blood pressure from HBPM readings?
Discard the measurements taken on the first day and use the average value of all the remaining measurements to confirm a diagnosis of hypertension
How do you work out the blood pressure from clinic readings?
Take a second measurement during the consultation.
If the second measurement is substantially different from the first, take a third measurement.
Record the lower of the last 2 measurements as the clinic blood pressure.
If a patient has a clinic BP in the range 140/90-179/119, what are the 3 next steps in management?
- ABPM, if this is unsuitable then HBPM
- Investigate target organ damage
- Calculate QRISK3 score
How do you explain what is meant by target organ damage by hypertension?
Changes in structure or function of organs due to damage from high blood pressure
The 4 main target organs are heart, brain, kidneys and eyes
Target organ damage can increase risk of cardiovascular events such as stroke, heart failure, kidney disease
Which initial investigation is done to confirm target organ damage to the heart, by hypertension?
12-lead ECG
To look for left ventricular hypertrophy
Which initial investigation is done to confirm target organ damage to the eyes, by hypertension?
Fundoscopy
To look for hypertensive retinopathy
Which initial investigation is done to confirm target organ damage to the brain, by hypertension?
Blood tests: HbA1c, U&Es, serum cholesterol and HDL
To look for diabetes and atherosclerosis
Which initial investigation is done to confirm organ damage to the kidneys, by hypertension?
Urinalysis: Urine dip stick and urine albumin: creatinine ratio
To check for hematuria and proteinuria (signs of CKD)
How do you explain to a patient what QRISK3 is?
A scoring tool used to estimate a person’s risk of developing a heart attack or stroke (CVD event) over the next 10 years
If a patient has clinic BP that suggests stage 3 hypertension and is asymptomatic, what is the initial management?
Initial investigations for target organ damage
