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Flashcards in FN: Hypertension Deck (13):
1

Definitions of Hypertension

Stage 1: Clinic BP >140/90
Stage 2: Clinic BP > 160/100
Severe: ClinicBP > 180/110

2

Malignant hypertension

BP > 180/110 + papilloedema and/or retinal haemorrhage

3

Isolated SHT

SBP > 140
DBP <90

4

Aetiology: PREDICTION

Primary: 95%
Renal: RAS, GN, APKD, PAN
Endo: increased T4, Cushings, phaeo, acromegaly, Conn's
Drugs: cocaine, NSAIDs, OCP
ICP increase
CoA
Toxaemia of regnancy (PET)
Increased viscosity
Overload with lfuid
Neurogenic: diffuse axonal injury, spinal section

5

End-organ damage: CANER

Cardiac:
1. IHD
2. LVH - CCF
3. AR, MR

Aortic:
1. Aneurysm
2. Dissection

Neuro:
1. CVA: ischaemic, haemorrhagic
2. Encephalopathy (malignant HTN)

Eyes: hypertensive retinopahty

Renal:
Proteinuria
CRF

6

Eyes: Hypertensive retinopthy classification

Keith-wagener Classification
1. Toruosity and silver wiring
2. AV nipping
3. Flame haemorrhage and cotton wool spots
4. Papilloedema

Grades 3 and 4 - malignant hypertension

7

Investigations

1. 24h ABPM
2. Urine: Haematuria, Alb: Cr ratio

3. Bloods: FBC, U +Es, eGFR, glucose, fasting lipids
4. 12 lead ECG: LVH, old infarct
5. Calculate 10 yr CV risk

8

Management

Do ABPM o confirm Dx before Rx (unless severe HTN)

9

Lifestyle interventions

increase excercise
Decrease smoking, decrease EtOH, decrease salt, decrease caffeine

10

Indications for pharmacological treatment

20%
3. Established CVD
4. DM
5. Renal disease

Anyone with stage 2 HTN (>160/100)
Severe/ malignant HTN (specialist referral)
Consider specialist opinion if <40 yrs with stage 1 HTN and no end organ damage.

11

BP targets

Under 80yrs <150/90

12

CV risk Management

Statins indicated for primary prevention if 10 yr CVD risk >20%
Aspirin may be indicated: evaluate risk of bleeding

13

Malignant HTN

Controlled reduction in BP over days to avoid stroke
Atenolol or long-acting CCB PO
Encephalopathy/CCF: fruse + nitroprusside/labetalol IV
1. aim to reduce BP to 110 diastolic over - 4h
2. Nitroprusside requires intra-arterial BP monitoring

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