Hypertension Flashcards
(44 cards)
what is hypertension
high blood pressure above 140/90 in clinic or 135/85 not in clinic
causes of hypertension
essential/primary
or
secondary:
R - renal disease; could be renal artery stenosis
O - obesity
P- pre-eclampsia
E - endocrine (conn’s syndrome which is hyperaldosteronism)
what is hypertension a major risk factor for?
stroke IHD heart failure CKD cognitive decline premature death
for every 2mm rise in BP, risk increases by 10%
how do you measure BP NICE guidance
measure BP in both arms, if difference in readings between both is 15mmHg and then take the highest
if pulse irregularity: measure manually
if BP in clinic is 140/90 or higher, take second then third and then lowest
if BP is between 140/90 and 180/120, offer ambulatory BP monitoring to confirm the diagnosis of HT
what is ABPM and HBPM
ambulatory - reflects patients BP, constantly measures it over 24 horus
HPMB - allows patients to measure their own BP, 2 consecutive measures, twice daily, for 4-7 days and discard measurements
what are the stages of HT
stage 1: 135/85 to 149/94
stage 2: 150/95 to 179/119
stage 3: >180/120 (can result in hypertensive emergency aka malignant hypertension)
what is hypertensive urgency
systolic >180 mmHg or diastolic >110
what are the symptoms of HU
headache
SOB
nose bleed
severe anxiety
management of HU
oral anti-hypertensives
treat as outpatient
no target organ damage
what is hypertensive emergency
malignant hypertension
- high BP leads to target organ damage
- systolic >180, or diastolic >120
what are the symptoms of hypertensive emergency
chest pain SOB back pain numbness and weakness vision change difficulty
can have severe, permanent effects on brain, heart and kidneys
how do you manage hypertensive emergency
IV nitroglycerine on admission
then IV and oral hypertensive drugs:
- peripheral vasodilators
- adrenergic inhibitors - eg labetalol
reduce 25% of BP over first few hours, then slowly over the next 24-48 hours to normal:
rapid drop should be avoided bc may precipitate cerebral or cardiac ischaemia
what investigations would you do for end organ damage
bloods:
- u&Es, GFR: renal function
- HbA1c
- lipid profile
- urine albumin:creatinine ratio - for proteinuria and dispstick for microscopic haematuria to assess for kidney damage
ECG for cardiac abnormalities
what is eye damage in hypertension
hypertensive retinopathy
grade 1: arteriosclerosis with moderatue vascular wall changes, to more severe hyperplasia
grade 2: AV nipping; predisposes to branch retinal vein occlusion (painless temporary vision loss)
grade 3: flame haemorrhages and cotton wool spots
grade 4: papilledema (optic disc oedema and yellow, hard exudates
end organ damage - brain
hypertensive cerebrovascular disease
end organ damage - heart
left ventricular hypertrophy, IHD with or without heart failure
- concentric hypertrophy or LV muscles, eventually decreasing stroke volume
- cardiomegaly
- dilated LV - displaced apex beat
- hypertrophied LV - tapping, powerful, apex beat
end organ damage - kidney
hypertensive nephropathy
-decreased blood flow to the kidneys from arterioral vasoconstriction = renin release = resulting in worsening hypertension via angiotensin 2 and aldosterone
-damaged glomeruli and decreased eGFR
what is the qrisk score
an algorithm for predicting CV risk estimates the risk of a person developing CVD over the next 10 years
NICE
what are the lifestyle factors involved in hypertension
healthy diet salt - reduce dietary sodium intake coffee - discourage excess smoking alcohol intake - reduce if in excess regular exercise
what is first line treatment for hypertension
ACE-I or ARB’s: if patients have diabetes or if they are <55 or if they are not african caribbean
CCB: if >55, or black african or caribbean any age
what is the second line treatment
ACE-I or ARB’s
+
CCB or thiazide-like diuretic
if black, >55 etc, then CCB + ACE-I or ARB or thiazide
what is the third line treatment
ACE-I or ABR + CCB + thiazide
what is step 4 in hypertension treatment
confirm resistant hypotension, give spironolactone if blood potassium level is <4.5 or alpha-blocker or beta-blocker if potassium >4.5
what is pheochromocytoma
tumour of adrenal gland tissue
- paroxysmal elevations in BP
- triad of headache, palpitations and sweating
