Hypertension - Treatment Flashcards
(66 cards)
What investigation is essential to confirm it is true hypertension?
ABPM (gives true reading)
At what time of the day are ABPM readings usually taken?
daytime, nighttime is best but can be uncomfortable for patient.
What are the risk factors of morbidity to look out for in the history of a hypertensive?
(6)
- Previous MI, stroke, IHD
- Smoker
- Diabetes
- Hyperlipidaemia
- Family history (of CVD)
- Physical Examination
Other than ABPM, outline other investigations which may be carried out to diagnose hypertension.
(4)
- ECG
- Bloods
- Urine dipstick
- Renal ultrasound/tests
What is an ECG used to look for in hypertensives?
Left ventricular hypertrophy
assess end-organ damage
What is a urine dipstick used to look for in hypertensives?
2
- haematuria
- proteinuria
What conditions should be screened for, which are treatable causes of secondary hypertension (secondary)?
(5)
- Renal artery stenosis
- Cushings disease
- Conn’s Syndrome
- Sleep apnoea
- Coarctation of the aorta
What are the signs of hypertension picked up on an ECG? (2)
What do these indicate?
- deep S waves in V1
- tall R waves in V5
Left ventricular hypertrophy
The BHS suggest target pressure should be < ________ mmHg.
135/80-85
Why do we treat hypertension?
2
- to reduce risk of further complications
- e.g. MI, stroke, CVD, renal impairment, retinopathy
What type of approach is taken to treat hypertension? (1)
Why is this approach used? (1)
- stepped
- increasing the dose of the initial medication comes with an increased likelihood of side effects.
- therefore it is better to use low doses of several drugs.
What is the first step of medication treatment for younger hypertensives (<55)?
Why this specific drug?
ACE inhibitor/ARB
Young people have higher levels of renin.
What is the first step of medication treatment for older/black population hypertensives (>55)?
- Ca2+ channel blockers (old)
- thiazide-type diuretic (blacks)
Anti-hypertensive treatment should be offered to patients <80 with ___________ plus one of the following what?
(1)
(5)
ABPM of 135/85mmHg (Type I)
- target organ damage
- established cardiovascular disease (LVH, CHF, CHD)
- renal disease
- diabetes
- a 10-year cardiovascular risk equivalent to 20% or greater
Anti-hypertensive treatment should be offered to which type II hypertensives?
What will their ABPM be if they are stage 2 hypertensive?
People of any age
150/95mmHg
Who should be referred to a specialist for further evaluation?
Why should they be referred to a specialist?
Patients <40 with type I hypertension or greater.
They are likely to have secondary hypertension, and further investigation is required to find the treatable cause.
How does treatment of hypertension differ in people aged 80 or greater?
(2)
- they are offered the same anti-hypertensive drugs as age group 55-80.
- they have a higher target BP = <145/85
What must be carried out or measured when a patient is suspected of white coat hypertension?
ABPM or HBPM
What is the step 1 treatment of hypertensives >55 and for black populations?
(2)
- calcium channel blockers
- given to black people of any age (not only >55)
Why might a calcium channel blocker be unsuitable i.e. what might it lead to?
(3)
- intolerance
- oedema
- evidence/risk of heart failure
What alternative drug may be offered if CCBs are unsuitable e.g. intolerance?
- thiazide-type diuretics
How should you treat if the BP does not seem to be lowering after starting a CCB?
- add on treatment of another drug
- do not increases dosage of original drug
Who should ACE inhibitors and ARBs not be offered to?
Why?
- black/afro-caribbean: less effective, leads to angioedema
- women of child baring age: teratogenicity
What is step 2 of treatment for hypertension?
- add thiazide-type diuretic to treatment regime (on top of ACEI or CCB depending on age)
