Hypertension Flashcards
(28 cards)
what is hypertension?
= high blood pressure
the level of blood pressure where treatment does more good than harm
when should blood pressure be measured?
- in a relaxed temperature setting
- person quiet and seated
in people with symptoms of postural hypotension, how should you measure blood pressure?
- measure blood pressure with the person supine or seated
- measure blood pressure again with the person standing for at least 1 minute prior to measurement
what are the 2 ways hypertension can be measured?
1) home BP
2) ABPM
(ambulatory blood pressure monitor)
when using the ABPM machine, when should the measurements be taken?
= at least 2 measurements per hour during the persons usual waking hours (usually 14/day)
when using the HBPM machine, when should the measurements be done and how?
= two consecutive seated measurements, 1 minute apart
- BP recorded 2x a day for at least 4 days & preferably 7 days.
- measurements are discarded on first day & the average value of all remaining are used
in the white coat hypertension, who is at the greatest risk factor?
- older female
- smoker
- high clinical SBP (systolic blood pressure)
- variable daytime readings
what is the blood pressure for stage 1 hypertension?
= BP of 140/90mmHg or higher
AND
= ABPM or HBPM daytime average of 135/85mmHg or higher
what is the blood pressure for stage 2 hypertension?
= BP of 160/100mmHg or higher
AND
= ABPM or HBPM daytime average of 150/95mmHg or higher
what is the blood pressure for severe hypertension?
= BP of 180mmHg or higher OR
= diastolic BP of 110mmHg or higher
for people with hypertension, what should you offer to measure?
1) test urine for present of protein
2) take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate & cholesterol
3) examine fundi for hypertensive retinopathy
4) arrange a 12 lead ECG
what is the main driver of absolute risk for hypertension?
age
what is another risk factor for hypertension?
= end organ damage
give 4 examples of end organ damage, that is a risk factor for hypertension?
1) left ventricular hypertrophy
2) creatinine raised
3) albuminuria/microalbuminnuria
4) retinopathy
what are 4 established diseases that act as a risk factor for hypertension?
1) ischaemic heart disease
2) cerbro-vascular disease
3) peripheral vascular disease
4) diabetes
what is hypertensive retinopathy?
retinal vascular damage caused by hypertension.
what are 4 signs to look out for in hypertensive retinopathy?
1) flame heamorrhage
2) papilloedema
3) cotton wool spot
4) hard exudate
what should people under the age of 55 be treated with?
= step 1 anti-hypersensitive treatment
- with an angiotensin-converting enzyme (ACE) inhibitor
OR
- low cost angiotensin II receptor blocker (ARB)
in hypertension, what should NOT be combined?
- ACE inhibitor with an ARB
what should people over the age of 55 and black people of African or Caribbean origin of any age be treated with?
= step 1 anti-hypersensitive treatment
- calcium channel blockers (CCB)
if there is any risk of heart failure or risk of heart failure, what should be given?
= thiazide like diuretic
if blood pressure is not controlled by step 1 treatment, what should be done?
- offer step 2 treatment with a CCB in combination with either ACE inhibitor or an ARB.
for people undergoing drug treatment what is the blood pressure target for people under age of 80 and people over age of 80?
Under 80
= 140/90mmHg
80 & over
= 150/90mmHg
for people with the white-coat effect undergoing treatment, what is the aim target for ABPM/HBPM in people over the age of 80 and under the age of 80?
Under 80
= below 135/85mmHg
Aged 80 & over
= below 145/85mmHg
