Hypertension Flashcards
(21 cards)
Definition of hypertension
Blood pressure of greater than 140/90mmHg
Treatment parameters for hypertension
Most patients we aim to get under 160/100
Patients with a high risk of a coronary artery event (>20% in 10 years), diabetics and those with evidence of end organ damage require blood pressure under 140/90
Definition of white coat hypertension.
When the patient has an elevated blood pressure in clinic, but a normal ambulatory blood pressure
Management of white coat hypertension
No management - but these patient have an increased risk of developing hypertension in the future, and have an increased cardiovascular risk
Definition of malignant hypertension
A rapid rise in blood pressure causing vascular damage
- more common in young, black patients
Pathological hallmark of malignant hypertension
Fibroid necrosis
Signs and symptoms of malignant hypertension
Headaches Visual disturbance Very severe hypertension: a systolic over 100, and/or a diastolic over 130 Bilateral retinal haemorrhages Bilateral retinal exudates Papilloedema
Why is urgent treatment of malignant hypertension required
Prevention of hypertensive emergencies such as AKIs, heart failure and encephalopathy
Definition of primary hypertension
Hypertension with no known cause (95% of cases)
Definition of secondary hypertension
Hypertension due to a known cause that can be treated - 5% of cases of hypertension
Renal causes of secondary hypertension
Intrinsic renal disease - glomerulonephritis - PAN - systemic sclerosis - chronic pyelonephritis - polycystic kidney disease Renovascular disease - atheromas (due to age, smoking or PVD) - fibromuscular dysplasia
Endocrine causes of secondary hypertension
Cushing/Conn’s syndrome
Pheochromocytoma
Acromegaly
Hyperparathyroidism
Causes of secondary hypertension (excluding renal and endocrine causes)
Pregnancy Aortic Coarctation Liquorice Drugs - amphetamines - cocaine - MDMA - oral contraceptive pill - steroids
Four stages of hypertensive retinopathy
1) tortuous arteries with thick, shiny walls
2) AV nipping (narrowing where arteries cross veins)
3) flame haemorrhages and cotton-wool spots
4) papilloedema
Signs and symptoms of secondary hypertension
Known renal disease Radio-femoral delay Weak femoral pulses Renal bruits Palpable kidneys Cushingoid features Signs of end organ damage - left ventricular hypertrophy - retinopathy - proteinuria
When should hypertension be treated
Confirm diagnosis
- home BP monitor readings/ambulatory BP monitoring
Treat if BP >160/100
If BP is >140/90, assess cardiovascular risk, check for diabetes and end-organ damage
How to investigate for end-organ damage
ECG and echo - LVH
Urinalysis for blood and protein - AKI
Fundoscopy - retinopathy
Assessment for the specific causes of secondary hypertension
Conn’s syndrome - U&Es for hypokalaemia
Primary hyperparathyroidism - calcium and PTH levels
Renal artery stenosis - renal USS or angiography
Pheochromocytoma - 24hr urinary adrenaline
Cushing’s syndrome - urinary free cortisol
Aortic coarctation - MRI of aorta
Renin and aldosterone levels
What lifestyle changes are recommended for hypertension management
Smoking cessation Healthy diet (low salt and low fat) Reduce alcohol intake Exercise Weight loss (if required)
What medication is used to treat primary hypertension
Age <55 or diabetic
- ACE inhibitor/ARB
- then add CCB
Age >55 or black
- CCB
- then add ACE inhibitor/ARB
If further medication required you can add a Thiazides
Beyond this specialist help is needed (aspirin, alpha-blockers, beta-blockers)
Consider statins if hypercholesterolaemia
Management of malignant hypertension
Bed rest
Calcium channel blocker or atenolol (unless encephalopathy or congestive cardiac failure)
Aim for a controlled drop in BP as cerebral autoregulation is poor (risk of stroke)
