Hypertension Flashcards
(28 cards)
What is Primary Hypertension
Hypertension with no identifiable cause (90% of hypertension patients)
What are the risk factors of Primary Hypertension
Age
Smoking
Genetics/family history
Obesity
Alcohol intake
Salt intake
What is Secondary Hypertension
Hypertension caused by an identifiable singular cause that when removed brings down the BP to normal
What can be causes for secondary Hypertension
Renal disease
Endocrine - adrenal gland hyper function/tumours, aldosteronism, Cushing’s, pheochromocytoma
Coarction of aorta
Drugs
Pregnancy
What are the subtypes of hypertension
Benign Hypertension
Malignant Hypertension
White Coat Hypertension
What is Benign hypertension
Stable elevated BP over many years
Asymptomatic
What are the consequences of Benign Hypertension
LV Hypertrophy (thickening of the wall of the Left ventricular heart chamber)
Congestive cardiac failure
Increased Atheroma
Thickening of Tunica Media
Aneurysm rupture
Renal Disease
What is Malignant Hypertension
Acute severe elevation of BP - diastolic pressure >130-140 mmHg
What can Malignant Hypertension develop from
Benign primary or secondary hypertension or from nothing
What can Malignant Hypertension lead to
Needs urgent treatment to prevent death:
Cerebral oedema
Acute renal and heart failure
Haemorrhage
What is White Coat Hypertension
Hypertension that only exists when BP is measured during medical consultations
Difference of more than 20/10 mmHg between clinical and average daytime ABPM
What is Stage 1 Hypertension
Clinical BP 140/90 mmHg or higher
ABPM or HBPM daytime average 135/85 or higher
What is Stage 2 Hypertension
Clinical BP 160/100 mmHg or higher
ABPM or HBPM daytime average is 150/95 mmHg
What is severe Hypertension
Clinical systolic BP is 180 mmHg or higher or
Clinical Diastolic BP is 110 mmHg or higher
What are symptoms of Malignant hypertension
Headache
Blurred vision
Chest pain
Altered mental status
When would you use ABPM and HBPM
ABPM if clinical BP>140/90 mmHg
HBPM if ABPM declined/not tolerated
How do you monitor for end organ damage
Urine - Haematuria (blood in urine), Alb:Cr ratio
Bloods - FBC (full blood count), U+Es (Urea and Electrolytes), Glucose, fasting lipids, electrolytes
Fundoscopy - hypertensive retinopathy
12 lead ECG
Calculate 10 year CV risk
How is stage 1 hypertension usually managed
Lifestyle intervention alone
What is step 1 of medical management in <=55 year olds
ACE-inhibitor (e.g. ramipril)
If unable to tolerate ACE-inhibitor switch to ARB (e.g. candesartan)
What is step 1 of medical management in >55 year olds or African or Caribbean ethnicity
DHP-Calcium channel Blocker (e.g. nefedipine)
What is step 2 of medical management
If maximal does of step 1 has failed or not tolerated:
Combine CCB and ACE-i/ARB
What is step 3 of medical management
If maximal does of step 2 has failed or not tolerated:
Add thiazide-like diuretic (e.g. indapamide)
What is step 4 of medical management if blood potassium is <4.5 mmol/L
Add spironolactone
What is step 4 of medical management if blood potassium is >4.5 mmol/L
Increase thiazide-like diuretic dose
Add alpha blocker (e.g. doxacosin)
Add beta blocker (e.g. atenolol)
Referral to cardiology for further advice
