hypertension Flashcards
(24 cards)
what is hypertension?
- high sustained arterial pressure
- 140/90
what is hypertension a risk factor for?
- cerebral haemorrhage
- atheroma
- renal failure
- sudden cardiac death
how is blood pressure calculated?
- cardiac output x peripheral resistance
what is primary hypertension?
- 90% of cases
- salt intake -25% salt sensitive
- renin - angiotensin system
- sympathetic activity
what is salt sensitive hypertension?
- increase in salt = increased BP
- in renal 27 hypertension is usually salt sensitive
what are the common causes of secondary hypertension?
- renal disease
- endocrine disease
- aortic disease
- renal artery stenosis
- drug therapy
how do renal causes cause secondary hypertension?
- eg renal artery stenosis
- reduced renal blood flow
- excess renin release
- salt and water overload
how do endocrine causes cause secondary hypertension?
- adrenal gland hyperfunction/tumours
- conn’s syndrome - excess aldosterone
- cushing syndrome - excess corticosteroid
- phaecochromocytoma - excess noradrenaline
what can benign hypertension cause?
causes
- left ventricular hypertrophy
- congestive cardiac failure
- increases atheroma
- increases aneurysm rupture
- renal disease
what is left ventricular hypertrophy?
- increase LV load
- poor perfusion
- interstitial fibrosis
- micro-infarcts
- diastolic dysfunction
what are the consequences of benign hypertension?
- every 10mmHg of diastolic pressure above 85 double risk of MI
- every 8mmHg of diastolic pressure above 85 double risk of stroke
what is malignant hypertension?
- diastolic pressure >130-140
- can develop from either benign or secondary hypertension
- needs urgent treatment
- causes cerebral oedema
- acute renal failure
- acute heart failure
what is pregnancy associated hypertension?
- increased maternal and fetal morbidity/mortality
- ## pre-eclampsia = hypertension and proteinuria
when using ABPM to confirm diagnosis, what must you ensure?
- at least two measurements per hour during the person’s usual waking ours
when using HBPM to confirm diagnosis, what must you ensure?
- two consecutive seated measurements, 1 minute apart
- BP is recorded twice a day for at least 4 days and preferably for 7 days
- measurements on the first day as discarded - average value a=of all remaining is used
what is stage 1 hypertension?
- clinic BP of 140/90mmHg or higher
- ABPM or HBPM daytime average of 150/95mmHg or higher
what is stage 2 hypertension?
- clinic BP or 160/100 or higher
- ABPM or HBPM daytime average of 150/95 or highrt
what is stage 3 hypertension?
- clinic BP is 180 or higher
- clinic diastole BP is 110 or higher
what are you arrange for someone with hypertension?
- test urine for presence of protein
- take blood to measure glucose, electrolytes, creatine, estimated glomerular filtration rate and cholesterol
- examine fundi for hypertensive retinotherapy
- arrange a 12 lead ECG
what are the risk factors of hypertension?
- end organ damage eg left ventricular hypertrophy, creatine raised, albuminuria, retinopathy
- age
what BP should be aimed for?
- 140/90 in under 80s
- 150/90 in above 80s
what ABPM or HBPM BP should be aimed for?
- below 135/85 in under 80s
- below 145/85 in above 80s
what lifestyle choices should be suggested?
- diet (no salt)
- exercise
- weight loss
- alcohol consumption
- smoking
what are the treatment pathways for hypertension?
- under 55 = A
- above 55/african/carrbbean of any age = C
- A + C
- A + C + D
- resistant hypertension = A + C + D + consider further diuretic or alpha/beta blocker, consider seeing expert advice
