Hypertension Flashcards
(41 cards)
Key main methods of measuring BP
1) ABPM - Ambulatory method
2)Home monitoring
3) Clinical
What are the main risk factors of hypertension?
- Main cause of it is still unknown
- Age,ethnicity, dietary salts, exercise and smoking
- Secondary causes- Renal disease and endocrine disease
What actually is established CVD
Conditions affecting the heart:
- medical history of stroke
- Tia
- Heart attacks
-Mia
- Narrow arteries
- Angina
What are examples of target organs?
Heart,brain, kidney CKD, eyes = damage = higher blood pressure
Nice definition of Hypertension - STAGE 1
Clinical BP = more than 140/90 -160/100 mmHg
Ambulatory /home BP = more than 135/85 mmHg
Stage 2
Stage 2
Clinical BP >= 160/100-180/120mmHg
AMBULATORY/HOME BP= >135/85 mmHg
Stage 3 - Severe hypertension
Clinical systolic = > 180 mmHg
Or clinical diastolic => 120 mmHg
What is resistant hypertension?
High blood pressure at repeated clinical encounters
Accelerated or Malignant Hypertension
Very very high BP
Severe increase in BP top over 180/120 mmHg and often 210/120 mmHg
WITH signs of:
- Retinal Haemorrhage
- And or papilloedema (swelling of the optic nerve)
- usually associated with target organ damage
= SAME DAY REFFERAL !!!
Hypertension diagnosis’s
Clinical BP between 140/90 - 180/120 mmHg - Offer ABPM/Home to confirm diagnosis
Then investigate target organ and assess CVD risk
After checking the clinical BP and its over 140/90 and APM is over 135/85
1) confirmed hypertension
2) no hypertension but organ damage
Need to investigate cause
3) no hyp and no organ damage = measure clinical BP at least every 5 years and more frequently if BP is closing 140/90 mmHg
What happens if BP is between 140/90 and 180/120 clinical?
Offer ABPM - to confirm diagnosis offer at home if ABPM is not suitable
Whilst waiting?
Investigate target organ damage, CVD risk using the calculator tools
When do we give treatment in stage 1?
If they have a higher BP (140/90)
1) under the age of 80 and one of the following (target organ damage, established CVD,Renal disease, 10 year risk = then give meds
2) Absence of these = just lifestyle
If they are over the age of 80 = if their BP is over 150 /90 =Drug treatment and lifestyle
3)Under the age of 40, investigate the causes of hypertension
4) is they’re under the age 60 - estimate the QRISK and lifestyle advice
Stage 2 when do we give treatment -
Regardless of age, treat!
Stage 3 treatment
Treat promptly with IV hypertensives
Accelerated malignant hypertension - with sever increase in BP over 180/120 and signs of retinal haemorrhaging and papilloedema(swelling of the optic nerve)
Same Day referral
Severe hypertension (180/120) with any of the following: Retinal haemorrhage, life threatening symptoms, suspected postural hypotension, headaches, palpitations, abdominal pain)
If patient has severe hypertension, but no symptoms or signs indicating same day referral then just carry out an investigation for target organ damage ASAP
If target organ damage, consider starting antihypertensive treatment immediately without waiting for results of ABPM OR HOME
If no target organ damage, repeat clinical Bp within 7 days
Hypertension with Type 2 diabetes, under the age of 55 and not Afro Carb
1) ACEi/ARB
2) ACEi or Arb + CCB or Thiazide like diuretic
3) ACEi/ARB + CCB + Thiazide like diuretics
4) confirm resistant hypertension, confirm elevated blood pressure with ABPM or HBPM, check postural hypotension and discuss adherence, seek expert if uncontrolled optimal tolerated dose
Hypertension without Diabetes and over the age of 55, or Afro C
1) CCB
2) CCB, Ace or arb or thiazide like diuretic
3) low dose Spirnolactone if K level is lower than 4.5
If its more use an alpha or beta blocker
Arbs are preferred over ACEi when?
Black and African/Afro Caribbean patients
All patients with type 2 diabetes should be offered …
Ace or ARB regardless of age or family origin
If patient not tolerating CCB - because of oedema or Hf …
Offer thiazide diuretic (indapamide and bendroflumethazide (indapamide is preferred over bendro unless the patient is stable on bendro)
Avoid ACE when..
Afro Caribbean, severe renal disease, pregnancy/breast feeding, Aliskiren with eGFR under 60 or diabetic angioedema
Side effects - Angiodema, coughing, hyperkalaemia
Avoid Arbs when…
Afro, renal, breastfeeding, aliskiren with eGFR less than 60 or angiodema
Side effects = hyperkalaemia or angiodema
