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Flashcards in Hypertension Deck (39)
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1

what is essential hypertension?

a rise in blood pressure of unknown cause that increase risk for cerebral, cardiac and renal events

2

what did the Framingham study assess?

the risk of coronary heart disease, stroke and heart failure in a 36 year follow up of patients aged 35-64

3

for individuals aged 40-69 years old, when does CV mortality risk double?

with each 20/10 mmHg
increased to blood pressure

4

what is hypertension?

the level of blood pressure where the treatment does more good than harm

5

how do you confirm the diagnosis of hypertension if the clinic BP is 140/90 mmHg or higher?

offer ambulatory blood pressure monitoring
(ABPM)

6

how do you confirm the diagnosis of hypertension if the clinic BP is 140/90 mmHg or higher but the patient is unable to tolerate ABPM?

home blood pressure monitoring (HPBM)

7

when would you start an anti-hypertensive drug solely on the clinic BP results, without waiting for the result of ABPM or HBPM?

if the patient has severe hypertension
(clinic SBP is 180mmHg+
or clinic DBP is 110mmHg+)

8

to confirm a diagnosis, what readings must you ensure the ABPM has got?

at least 2 measurements per hour during waking hours
14 days usually

9

to confirm a diagnosis, what readings must you ensure the HBPM has got?

2 consecutive measurements, 1 minute apart
BP recorded for at least 4 days (7 days preferred)
[measurements on the first day are discarded]

10

if hypertension is not diagnosed, how often do you want to measure the person's clinic blood pressure?

at least every 5 years
even more frequently if their clinic BP is nearing 140/90mmHg

11

what is state 1 hypertension?

clinic BP is 140/90 mmHg or higher
AND
ABPM or HBPM daytime average is 135/85 or higher

12

what is state 2 hypertension?

clinic BP is 160/100 or higher
AND
ABPM is 150/95

13

what is severe hypertension?

clinic systolic BP is 180mmHg or higher
OR
clinic diastolic BP is 110mmHg or higher

14

for all patients with diagnosed hypertension what 4 extra tests should you offer during the diasnosis stage?

- test urine for presence of protein
- take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholestero
- examine fundi for hypertensive
- 12 lead ECG

15

when measuring estimated CV risk what BP value should you use?

clinic BP

16

what is the % CV risk that diabetes gives?

20%+

17

what is the main driver of absolute CV risk?

age

18

what is the % CV risk that established vascular disease gives?

>20%

19

what is Grade I of the KWB classification of hypertensive retinopathy?

slight or modest narrowing of the retinal arterioles with the arteriovenous ratio >_ 1:2

20

what is grade II of the KWB classification of hypertensive retinopathy?

modest to severe narrowing of the retinal arterioles (focal or generalised) with an arteriovenous ratio below 1:2 or with arterial nicking

21

what is the grade III KWB classification of hypertensive retinopathy?

bilateral soft exudates or flame-shaped haemorrhages

22

what is the grade IV KWB classifiaction of hypertensive retinopathy?

bilateral optic nerve oedema

23

if a patient over 40 has stage 1 hypertension what is the management?
[CBPM 140/90mmHg or greater AND HBMP 135/85mmHg or greater]

lifestyle interventions

24

if a patient under 55 has stage 2 hypertension what is the step 1 management?

[CBMP 160/100mmHg or greater AND HBPM 150/95mmHg or greater]

anti hypertensive drug treatment with ACE inhibitor
(or ARB if ACE is not tolerated well)

25

what should you never combine an ACE with to treat hypertension?

ARB

26

if a patient over 55 has stage 2 hypertension what is the step 1 management?

[CBPM 160/100mmHg or greater AND HBMP 150/95mmHg or greater]

anti hypertensive drug treatment with calcium antagonist

(if calcium antagonisr not suitable use thiazide diuretic)

27

if a patient is of African or Caribbean family origin (any age) and has stage 2 hypertension what is the step 1 management?

[CBPM 160/100mHg or greater AND HBPM 150/95mmHg]

anti hypertensive drug treatment with calcium antagonist

(if calcium antagonist not suitable use thiazide-diuretic)

28

why might a calcium antagonist not be suitable for treatment of stage 2 hypertension in a patient over 55 or of black/caribbean origin?

oedema
heart failure
not tolerated

29

if a patient under 55 has stage 2 hypertension that is not controlled by step 1 treatment, what is the management?

[CBMP 160/100mmHg or greater AND HBPM 150/96mmHg or greater]

step 2:
add on a calcium antagonist with the step 1 ACE/ARB

(if calcium antagonist not suitable use thiazide diuretic)

30

if a patient is of African or Caribbean family origin (any age) and has stage 2 hypertension that isn't controlled with step 1 treatment, what is the management?

[CBPM 160/100mHg or greater AND HBPM 150/95mmHg]

step 2:
add on a ARB with the step 1 calcium antagonist/thiazide diuretic