Hypertension Flashcards
What causes hypertension?
Essential hypertension: idiopathic
Secondary:
Renal disease - glomerulonephritis, poly arthritis nodosa, PKD, renovascular
Endocrine - cushings, conns, phaeocytochroma, acromegaly
Pregnancy
NSAIDs
Recreational drugs
How often should adults have their blood pressure checked?
At least every 5 years
What are risk factors for hypertension?
Age African/Caribbean ethnicity High salt diet Obesity Smoking Drinking large amounts of alcohol Family history Sedentary lifestyle
What investigations may help to explore secondary causes of hypertension?
24 hour urinary metanephrines/catecholamines - if primary hyperaldosteronisms eg conns, phaeo
Urinary free cortisol/dexamethasone suppression test - cushings
Renin aldosterone levels - conns
Plasma calcium - increased in hyperparathyroidism
MRI/USS of renal arteries - renal artery stenosis
How is hypertension diagnosed in clinic?
BP >140/90
Severe hypertension is BP >180/110
How is BP diagnosed at home?
Stage 1 - BP >135/85
Stage 2 - BP >150/92
How is ambulatory blood pressure monitoring carried out?
Recommended if clinic test shows high BP
Measured 2x an hour 24 hours (or at least 14 readings)
Each recording done twice, at least 1 min apart
Use automated BP device
How is home blood pressure monitoring carried out?
If ABPM not tolerated
Two consecutive measurements taken, twice daily, in morning and evening
For at least four days, ideally seven days
Discard readings for day 1 and take an average value for the rest
What investigations should be done for target organ damage and formal assessment of cardiovascular risk?
Qrisk2
Urine analysis - ACR, haematuria
Bloods - cholesterol, HDL, UandEs, eGFR, plasma glucose, HBa1c
Examine fundi for retinopathy
12 leads ECG
Should Qrisk2 be used if a patient with hypertension has DM or Cardiovascular disease?
Qrisk2 is not necessary on this case as the patient has already justified treatment or lifestyle interventions
What lifestyle interventions should be recommended to patients with hypertension?
Increases exercise Diet - base meals on starchy foods, ear fruit Reduce alcohol Reduce salt intake Smoking cessation Group support initiatives Relaxation therapies
When should anti hypertensives be offered in hypertension?
If BP >140/90
Under 80
And: Target organ damage Established cardiovascular disease Renal disease Diabetes 10 year cardiovascular risk equivalent to 20% or greater (qrisk2)
What if stage 2 hypertension after ambulatory monitoring?
Offer anti hypertensives!
What is first line treatment for hypertensive patients under 55 and Caucasian?
Ace inhibitor
Ramipril 2.5mg OD
Or lisinopril, peripril
What is the first line treatment for patients over 55 or black person of African/Caribbean descent?
Calcium channel blocker
Amlodipine 5mg OD
Others: felodipine, nifedipine
