Hypertension Flashcards
What is high BP a major risk factor for
Stroke
Heart disease
What is important to ask in the history for HTN
Lifestyle - diet (salt), exercise, stress Drug hx Family hx - renal disease, CVS, HTN smoking Alcohol intake Changes in vision Headaches - episodic Dizziness or light headed ness Palpitations Sweating - paroxysmal Anxiety Diabetes symptoms - polydipsia, polyuria and weight loss bone pain pruritis
What is important to look out for in examination
Renal causes of HTN - are kidneys palpable, abdominal bruit (renovascular disease), delayed or weak femoral pulses (coarctation)
Does pt look cushingoid or is Conn’s syndrome present (tetany, polyurethane, weak muscles, hypokalaemia)
Signs of thyroid disease - dry skin, hair loss, slow pulse, puffiness around eyes and face
Check for HTN retinopathy - papilloedema
Urine dip - proteinuria and haematruria
What are the renal causes of secondary HTN
Glomerulonephritis Systemic sclerosis Polycystic kidney disease Chronic pyelonephritis Renovascular disease - renal stenosis
What are some endocrine causes of HTN
Cushing’s syndrome and Conns syndrome = both will have hypokalaemia in absence of diuretics
Phaeochromocytoma
Acromegaly
hyperparathyroidism
What are some other causes of secondary hypertension
Coarctation of the aorta COCP Pregnancy Steroids Monoamine oxidase inhibitors - if they eat cheese of tyramine rich foods --> hypertensive crisis
What are the complications of hypertension
Cerebrovascular disease
- ischaemic or haemorrhagic stroke
Vascular disease
- coronary artery disease - high pressures damage the walls –> atherosclerosis –> MI, angina etc
Left ventricular hypertrophy
- compensatory response
- pressure overload –> hypertrophied muscle –> diastolic dysfunction –> systolic dysfunction
Renal failure
- renovascular damage
- glomerular loss –> proteinuria
How would you investigate hypertension
Bedside obs
- urine dip - look for proteinuria, any glucose, haematuria
- Fundoscopy - check for retinopathy
Bloods
FBC
U+Es - hypokalaemia in conns and cushings
LFT
Bone profile - Calcium high in hyperpaprathyroidism
Renin:aldosterone
3x 24hr urinary VMA/free metadrenaline + normadrenaline - if phaeochromocytoma is suspected
Imaging
- uss or MRI if renal artery imaging needed
How is it graded
Optimal 120/80 Normal <130/<85 High-normal 130-139/86-89 Grade 1 (mild) 140-159/90-99 Grade 2 (moderate) 160-179/100-109 Grade 3 (severe) >180/>110
What needs to be checked before spironolactone can be added to treatment regime
Chck potassium is less than 4.5 mmol/L
Which thiazide diuretics are used in BP treatment
Chlortalidone 25-50mg
Indapamide 1.5mgMR/ 2.5mg OD
What are the BP targets for diabetics
No end organ damage 140/90
End organ damage 130/80
