HYPERTENSION Flashcards
(49 cards)
When is BP treatment initiated in the general adult population
140/90 or higher
When is BP treatment initiated in people over 60 years of age
150/90 or higher
Risk factors for primary hypertension
Age
Family history
Obesity
Sedentary lifestyle
When should BP treatment be initiated for patients with CKD or diabetes
140/90 or higher
Cardiovascular risk factors
Age (men ≥ 55 years; women ≥ 65)
Family history of premature cardiovascular disease (men aged < 55 years;
women aged < 65)
Dyslipidaemia
Obesity (BMI ≥ 30 kg/m2)
Diabetes mellitus
Smoking
Pulse pressure (in the elderly) ≥ 60mmHg
Microalbuminuria or proteinuria
Left ventricular hypertrophy
Left bundle branch block
Ischaemic heart disease
Previous stroke or TIA
Periperal arterial disease
Heart failure
Coronary artery disease
Chronic kidney disease
Advanced retinopathy:
Signs of advanced retinopathy
haemorrhages or exudates, papilloedema
Renal causes of secondary hypertension in adults
CKD
Polycystic kidney disease
Endocrine causes of hypertension in CKD
Phaeochromocytoma
Cushing’s syndrome
Conn’s disease
Hypothyroidism
Hyperthyroidism
Acromegaly
Investigations in hypertension
FBC
Chest X-ray
ECG
Urinalysis
BUE/Cr
Serum lipids
Blood glucose
Serum uric acid
Renal and adrenal ultrasound
Echocardiogram
Treatment objectives for hypertension in adults
To reduce blood pressure levels to recommended targets:
To manage co-morbid conditions
To prevent cardiovascular, cerebrovascular and renal complications
To promote therapeutic lifestyle changes
To identify and manage secondary hypertension appropriately
Recommended BP targets in adults
< 140/90 mmHg for age below 60 years, diabetes, CKD
< 150/90 mmHg for age above 60 years
Non-pharmacological interventions in hypertension
Reduce salt intake
Reduce animal fat intake
Ensure regular fruit and vegetable intake
Weight reduction in obese and overweight individuals
Regular exercise e.g. brisk walking for 30 minutes 3 times a week
Reduction in alcohol consumption
Avoid or quit smoking
First line drugs in hypertension
Thiazide Diuretics
Calcium Channel Blockers
Angiotensin Converting Enzyme Inhibitors
Angiotensin Receptor Blockers
Beta-blockers
Preferrable antihypertensive drugs in blacks
thiazide diuretics or calcium channel blockers, either as monotherapy or in some combination therapy
According to STG angiotensin converting enzyme Inhibitors are not recommended as first-line drugs for
uncomplicated hypertension in black patients. T/F
True
When should dual therapy be started
Dual therapy should be started earlier when the blood pressure exceeds
180/110 mmHg.
Preferred antihypertensives in left ventricular hypertrophy
ACEi/ARB
CCB, preferably amlodipine
Preferred antihypertensives in renal dysfunction
ACE-I or ARB; Caution- if eGFR <15min/ml without renal
replacement therapy
Preferred antihypertensive medications in microalbuminuria
ACEi or ARB
Preferred antihypertensive medications in previous stroke
Any of the first-line drugs, especially ACE-I
Preferred antihypertensive medications in coronary artery disease
ACE-I or ARB
Beta-blocker
CCB
Preferred antihypertensive medications in heart failure
ACE-I or ARB
Cardio-selective B-Blockers- bisoprolol, metoprolol, carvedilol
Loop diuretics
Spironolactone in advanced heart failure
Preferred antihypertensive medications in PAD
CCB
ACEi/ARB
Preferred antihypertensive medications in diabetics
ACEi/ARB
