Hypertension

Question 1

What is the determinants of BP

Answer 1

BP = CO x TPR
CO = Stroke Volume x HR (Stroke Vol is determined by contractility and fill of the heart)

Question 2

Pathogenesis of HTN

Answer 2

RF: Ageing, Na+ intake (increase CO), Dehydration/Heat stroke (decrease CO)

Question 3

Why is HTN often called the “Silent Killer”

Answer 3

typically no smx, usually presents as complications eg. target organ damage -> HF, kidney impairment

Question 4

Smx of severe HTN

Answer 4

• headaches, pulsating behind the eyes, usually early in mornings
• visual changes, blurred vision
• N&V

Question 5

Correlation btw SBP and CV risk

Answer 5

5mmHG SBP decrease = 10% CV risk decrease (17% CHD, 27% Stroke, 28% HF)

Question 6

BP Categories

Answer 6

Normal: <120 and <80
Elevated: 120-129 and <80
HTN stage 1: 130-139 or 80-89
HTN Stage 2: >=140 or >=90
Hypertensive crisis (emergency): >180 and/or >120

Question 7

Risk factors for CVD

Answer 7

• age
• smoking
  -fam Hx of premature CVD
• dyslipidemia
• DM
  obesity
• cerebrovascular disease (stroke, ischemic attack)
• heart disease
• renal disease
• vascular disease
• atherosclerosis

Question 8

When to treat HTN?

Answer 8

Usually high BP: 130-139/85-89mmHg can start lifestyles changes first then monitor 3-6months, if not working then start drug therapy.
If BP >140/90 usually drug tx is started but can still offer lifestyle changes first to pt and see what they prefer.
Esp if have comorbidities or high ASCVD/DM/kidney risk, btr to start drug tx earlier

Question 9

What are some non-pharm management for HTN?

Answer 9

1. Weight loss: every 10kg loss, remove 1 drug, every 1kg loss, 1mmHg decrease. Aim BMI <23kg/m2 and waist circumference <90cm (M) and <80cm (W)
2. Exercise: at least 30mins moderate exercise 5-7days/wk, >=150mins/wk. decrease -5/8 mmHg
3. DASH diet: low Na, higher K. More veg, fruit, fish, putry, nuts. Less diary, red meats, sweets
4. Quit smoking: decrease 5mmHg
5. Decrease caffeine, alcohol consumption: decrease 4mmHg
6. Reduce stress
7. Low salt diet/salt substitutes
8. Monitor own BP at home regularly

Question 10

Problem of inappropriate BP monitor cuff size

Answer 10

Undersized: raises BP -> too tight
Oversize: lowers BP -> too loose

Normal Adult cuff size:
- width 37-50% of limb’s length (length to width ratio 2:1)
- bladder 75-100% (wrap ard arm >75% of circumference)
- OTC usually sells 22-26cm arm circumference

Obese: consider wrist meters, place at lvl of heart. below heart- over reads, above heart- under reads

paediatrics: right arm BP unless coarctation of aorta + limb BP (supine)

Question 11

What to take note of when monitoring BP at home

Answer 11

• Take BP twice a day: Before breakfast, administration of meds, or exercise and then in evening. Measure at the same time every day.
• Avoid food, caffeine, alcohol 30mins prior to measurement
• Sit quietly during monitoring. Sit for 5 mins with legs and ankles uncrossed, back supported against a chair. Stay calm and don’t talk while taking BP. Dont talk and move.
• Position arm at rest, at level of your heart on a table or chair arm. Use a pillow or cushion as needed to elevate it.
• Place cuff on bare skin, not over clothing. Avoid rolling long sleeves up. For muslim women: make sure they wear loose clothing to allow rolling up of sleeves but sometimes no choice so home BP is impt.
• Wait for at least 1 minute before repeating. Write down the readings, average them -> give them BP chart to record.
• Ideally, 7 consecutive days readings. Min 3 days consecutively prior to the next apptm.
• Calibrate against clinic BP meter