Flashcards in HTN and Associated Changes Deck (23):
What is HTN in terms of BP cutoffs?
What is accelerated HTN?
Significant recent increase in BP over previous hypertensive levels associated with evidence of vascular damage on fundoscopy but without papilloedema
What is malignant hypertension?
High enough BP to cause papilloedema and other manifestations of vascular damage (retinal haemorrhages, bulging discs, mental status changes, increasing Cr).
Often BP >200/140
What is the aetiology of HTN?
-Essential /Primary HTN
-White coat HTN
Factors predisposing to HTN?
-High salt diet
Renal causes of secondary HTN?
-Renal parenchymal disease / glomerulonephritis / pyelonephritis / polycystic kidney disease
Endocrine causes of secondary HTN?
-Hyperthyroidism / hyperparathyroidism
-Hypercalcemia of any cause
Vascular causes of HTN?
-Coarctation of the aorta
-Renal artery stenosis
Causes of secondary HTN?
Bruits, Bad Kidneys
Coarctation, Cushings, Catecholamines, Calcemia
Ix in all pts w/ HTN?
-FBE: anemia CKD
-UEC: esp K+ (high in renal disease, low in aldosteronism)
-LFTs: fatty liver/ drug rxn
-Urine Alb:Cr ratio: evidence renal damage
-ECG: CAD / hypertrophy
Lifestyle Mx HTN?
-Low risk alcohol consumption
Pharmacological Mx HTN?
If partial response to standard monothearpy, add another first line drug in 2-3/52.
Step 1: A / C / D
Step 2: A+C / A+D
Step 3: A+C+D
What does HTN predispose to?
Is a person's avg BP ass/w CV risk?
Yes- relationship between BP and CV risk is continuous. Above 115/75mmHg, for each 20mmHg SBP increase CV/stroke risk doubles.
How is diagnosis of HTN made?
After 5 minutes seated rest
2 readings, 2mins apart.
-Additional visit 1-4/52
-24hour ambulatory measures
-Home BP measures
Important features to elicit in HTN Hx?
-PHx: CV / stroke events
-Renal disease symptoms
Examination features in HTN?
-Pulse rate and rhythm
-Full CV exam
-Renal bruits / masses
-Stigmata secondary causes
When should BP be treated?
normal pt, no other RFx
When should BP + risk be treated?
PLUS DM, CV / renal disease OR high CV risk
What are the high CV RFx?
-Total:HDL cholesterol ratio
-End organ damage
What is the end organ damage indicative of high CV risk?
-Microalbuminuria / low eGFR (renal damage)
-LV hypertrophy (cardiac damage)
-High pulse wave velocity (stiff large arteries)
-Increase intimal-media thickness (reflects atherosclerosis).
Considerations of ACEi/ARBs as first line choice in Mx HTN?