Hypertension Flashcards
(36 cards)
How is hypertension defined according to NICE
- a clinic reading persistently above >= 140/90 mmHg, or:
- a 24 hour blood pressure average reading >= 135/85 mmHg
What are the two main types of hypertension?
Primary (essential) hypertension and secondary hypertension.
Name 5 causes of secondary hypertension
- renal artery stenosis
- Conn’s syndrome (mc)
- Cushing’s syndrome
- NSAIDs
- pregnancy
- coarctation of the aorta
At what level does hypertension typically begin to cause symptoms?
When blood pressure is very high, e.g., > 200/120 mmHg
What symptoms may occur with very high blood pressure?
Headaches, visual disturbances, seizures.
What investigations should be done for newly diagnosed hypertension?
- ambulatory blood pressure monitoring
- Fundoscopy
- urine dipstick
- ECG
- Urea & electrolytes
- Bloods: HbA1c and lipid profile
What is the criteria for stage 1 hypertension
- Clinic BP >= 140/90 mmHg
- ABPM or HBPM average BP >= 135/85 mmHg
What is the criteria for stage 2 hypertension
- Clinic BP >= 160/100 mmHg
- ABPM or HBPM average BP >= 150/95 mmHg
What is the criteria for stage 3 hypertension
Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg
NICE recommends initially measuring blood pressure in both arms for the diagnosis of HTN. What should be done if the blood pressure difference between arms is > 20 mmHg?
Repeat measurements; if the difference persists, use the arm with the higher reading for future measurements.
What pathological condition may cause unequal arm blood pressure readings?
Supravalvular aortic stenosis
What should be done if the first clinic BP reading is > 140/90 mmHg?
Take a second reading and use the lower of the two for management decisions
When should ABPM or HBPM be offered according to NICE?
When clinic BP is ≥ 140/90 mmHg.
When should a patient be admitted immediately for hypertension?
If BP ≥ 180/120 mmHg and there are signs of retinal haemorrhage, papilloedema, or life-threatening symptoms (e.g., chest pain, acute kidney injury).
What is the next step if no immediate danger but BP ≥ 180/120 mmHg?
Urgent investigation for end-organ damage (e.g., bloods, ACR, ECG).
If target organ damage is identified in severe hypertension, what should be done?
Start antihypertensive treatment immediately, without waiting for ABPM/HBPM.
What is the recommended daily salt intake to help manage blood pressure?
Less than 6g/day, ideally 3g/day.
What are some lifestyle changes recommended for managing hypertension?
Reduce caffeine, stop smoking, reduce alcohol, eat more fruits and vegetables, exercise more, lose weight
When should patients with stage 1 hypertension (≥ 135/85 mmHg) be treated?
If < 80 years and they have target organ damage, CVD, renal disease, diabetes, or a ≥10% 10-year CV risk.
What is first-line drug treatment for hypertension in patients <55 or with type 2 diabetes?
An ACE inhibitor (e.g.ramipril) or an angiotensin receptor blocker (candesartan)
What is first-line drug treatment for hypertension in patients ≥55 or of Black African/Caribbean origin?
A calcium channel blocker (e.g. amlodipine)
What drugs are combined in step 2 treatment of hypertension?
- ACEi/ ARB + CCB/ thiazide-like diuretic or CCB + thiazide-like diuretic(e.g. indapamide)
What is the preferred second-line drug for treating hypertension in Black African or African-Caribbean patients already on a calcium channel blocker?
An angiotensin II receptor blocker, due to lower effectiveness and higher side effect rates with ACEi
What is the third step in hypertension drug treatment when two medications are insufficient?
Add a third drug to complete the combination of ACEi/ ARB, CCB and thiazide-like diuretics.
