Hypertension Flashcards
(55 cards)
with every increase of 20/10 mmHg in BP, how much does CV mortality risk increase?
it doubles
why must you take many readings and average them when using electric BP monitors?
they are less accurate than manual ones
Automated BP devices might not measure BP properly if there’s a pulse irregularity. True/ false?
True - so palpate pulse first to ensure it’s regular
how should BP be checked in people with symptoms of postural hypotension?
- measure BP supine or seated
- measure BP again after standing for 1 minute
- if systolic BP falls by 20mmHg or more: review medication, measure subsequent BPs with person standing, consider referral if symptoms persist
at what level of BP should ABPM be offered
clinic BP of 140/90mmHg (to confirm the diagnosis)
what should be done when considering diagnosis of hypertension?
- measure BP in both arms
- if difference is more than 20mmHg, repeat measurements.
- if it remains more than 20 difference - take 2 more readings in the arm with the higher reading
- if BP in clinic is over 140/90mmHg - take a second measurement. If this is substantially different - take a third. Record the lower of the last two measurements as the clinic BP.
what can be offered if person cannot tolerate ABPM?
HBPM
If severe hypertension - start treatment before getting ABPM/ HBPM results
how should ABPM be used?
take at least 2 measurements per hour during the person’s waking hours to confirm hypertension
how should HBPM be used?
- should be 2 consecutive seated measurements, 1 minute apart
- BP recorded twice daily (ideally morning and evening)
- BP recording continues for at least 4 days (ideally 7)
- discard the measurements of the first day and use the average of all the remaining measurements to confirm hypertension
what should be done if hypertension is not diagnosed, but there is evidence of target organ damage e.g. LV hypertrophy, albuminuria, proteinuria?
carry out investigations for alternative causes for the target organ damage
what is hypertension is not diagnosed after ABPM/ HBPM?
measure the person’s clinic BP every 5 years, maybe more often if BP is close to 140/90mmHg
define stage I hypertension?
clinic BP 140/90mmHg
AND
ABPM/ HBPM is 135/85mmHg
define stage II hypertension?
clinic BP 160/100mmHg
AND ABPM/ HBPM is 150/95mmHg
define severe hypertension?
clinic BP is 180mmHg
OR
clinic diastolic is 110mmHg
what tests should be offered to all with hypertension?
- test urine for protein
- test blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
- examine fundi for hypertensive retinopathy
- 12 lead ECG
what tool can be used to calculate risk?
assign score
what should be included in the assessment of the patient?
- medical history
- FH premature CV disease
- smoking
- repeated BPs (or ABPM or HBPM)
- examine fundi?
grade I hypertensive retinopathy?
slight / modest narrowing of the retinal arterioles, with an arteriovenous ratio > / = 1:2
grade II hypertensive retinopathy?
modest to severe narrowing of retinal arterioles (focal / generalised) with an arteriovenous ratio<1:2 OR arteriovenous nicking
grade III hypertensive retinopathy?
bilateral soft exudates or flame-shaped haemorrhages
grade IV hypertensive retinopathy?
bilateral optic nerve oedema
should ACE inhibitors ever be combined with ARBs?
No
what is first line anti-hypertension drug in those under 55 (white)?
ACE inhibitor
ARBs if can’t tolerate cough
what is the first line anti-hypertension drug in those over 55/ black?
calcium channel blockers
(if this is not suitable e.g. oedema/ intolerance/ heart failure/ risk of heart failure) –> offer a thiazide-like diuretic
