Hypertension (HTN) Flashcards Preview

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Flashcards in Hypertension (HTN) Deck (9)
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1
Q

Definition of HTN

A
  • Stage 1: Clinic BP >140/90 or HBPM ≥135/85
  • Stage 2: Clinic BP >160/100 or HBPM ≥150/95
  • Severe: Clinic BP >180/110
  • Malignant: BP >180/110 + papilloedema and/or retinal haemorrhage
  • Isolated SHT: SBP ≥140, DBP <90
2
Q

Aetiology of HTN (PREDICTION)

A
  • Prediction
    • Primary: 95%
    • Renal: RAS, GN, APKD, PAN
    • Endo: ↑T4, Cushing’s, phaeo, acromegaly, Conn’s
    • Drugs: cocaine, NSAIDs, OCP
    • ICP ↑
    • CoA
    • Toxaemia of Pregnancy (PET)
    • Increased viscosity
    • Overload with fluid
    • Neurogenic: diffuse axonal injury, spinal section
3
Q

Aetiological Clues

A
  • ↑HR: Thyrotoxicosis
  • RF-delay: CoA
  • Renal bruits: RAS
  • Palpable kidneys: APKD
  • Paroxysmal headache, tachycardia, sweating, palpitations, labile or postural hypotension: Pheochromocytoma
4
Q

Signs and Symptoms of HTN

A
  • Signs/symptoms include BP >140/90 mmHg and retinopathy.
  • Risk factors include obesity, low exercise, high alcohol intake, metabolic syndrome, diabetes, black ancestry, age >60 years, FHx of HTN or CAD and sleep apnoea.
5
Q

Investigation of HTN

A
  • 12-lead ECG
    • May show evidence of LVH or old infarction
  • Fasting metabolic panel
    • May show renal insufficiency
    • Hyperglycaemia
    • Hypokalaemia
    • Hyperuricaemia
    • Hypercalcaemia
  • Fasting lipid panel
    • High LDL
    • Low HDL
    • High triglycerides
  • Urinalysis
    • Proteinuria
  • Hb
    • Anaemia
    • Polycythaemia
  • TSH
    • High or low if thyroid dysfunction
  • Fundoscopy
    • Hypertensive retinopathy
6
Q

Management of HTN

A
  • Lifestyle modifications (i.e. smoking cessation, dietary modification, increased exercise)
  • CV risk management with statins
  • NB - In diabetic patients always start with ACE-I
7
Q

Complications of HTN

A
  • CAD
  • CVA
  • LCH
  • CHF
  • Retinopathy
  • PVD
  • CKD
  • Aortic dissection
  • Malignant HTN
8
Q

Treatment Targets

A
  • < 80 years - Clinic BP 140/90 or HBPM 135/85
  • ≥ 80 years - Clinic BP 150/90 or HBPM 145/85
  • T1DM - Clinic BP 135/85 unless albuminuria or 2 or more features of metabolic syndrome in which case 130/80
  • T2DM - Clinic BP 140/90 for <80 years and 150/90 for >80 years. SIGN recommend clinic BP 130/80.
9
Q

Secondary Causes

A
  • Renal
    • GN
    • Pyelonephritis
    • APKD
    • Renal artery stenosis
  • Endocrine
    • Phaeochromocytoma
    • Cushing’s syndrome
    • Conn’s syndrome
    • Thyroid dysfunction
    • Hypoparathyroidism
    • Liddle’s syndrome
    • Congenital adrenal hyperplasia
    • Acromegaly
  • Drugs
    • Steroids
    • Monoamine oxidase inhibitors
    • COCP
    • NSAIDs
    • Leflunomide
  • Other
    • Pregnancy
    • Coarctation of the aorta
    • Obstructive sleep apnoea