What is essential hypertension?
A rise in blood pressure of unknown cause that increases risk for cerebral, cardiac and renal events
How is hypertension diagnonsed?
If the clinic BP is 140/90 mmHg or higher, offer ambulatory BP monitoring (ABPM) to confirm the diagnosis of hypertension
What is ABPM?
At least two measurements per hour during the person’s waking hours
What is stage 1 hypertension?
Clinic BP of 140/90 mmHg or higher AND ABPM daytime average of 135/85 mmHg
What is stage 2 hypertension?
Clinic BP of 160/100 mmHg or higher AND ABPM daytime average of 150/95 mmHg
What is severe hypertension?
Clinic BP of 180 mmHg or higher or clinic diastolic BP of 110 mmHg or nigher
What tests should be offered to people with newly diagnosed hypertension to assess end organ damage?
Test urine for presence of proteinuria or raised levels of creatnine
Take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
Examine fundi for hypertensive retinopathy
Arrange a 12-lead ECG
What is an example of a risk calculator for CV disease?
Assign score
What are examples of end organ damage due to chronic hypertension?
Left ventricular hypertrophy
Creatinine raised
Albuminuria/microalbuminuria
Retinopathy
What are examples of established vascular disease?
Ischaemic heart disease
Cerbro-vascular disease
Peripheral vascular disease
Diabetes
How do you assess for risk of CV disease?
Medical history FMH Smoking CV exam (pulses bruits) Repeated BPs Examine fundi
What is the target blood pressure for those under 80?
140/90 mmHg
What is the target blood pressure for those ages 80 and over?
150/90 mmHg
What contributes to hypertension?
High triglycerides High cholesterol High heart rate High BMI High Haematocrit
What does a 5mmHg reduction in BP do to your risk of stroke?
Decreases the chance of stroke by 40%
What are common causes of secondary hypertension?
Renal disease
Obstructive sleep apnoea
Aldosteronism
Reno-vascular disease
What are uncommon causes of secondary hypertension?
Cushing's Pheochyomocytoma Hyperparathyrodism Aortic coarctation Intercranial tumour
What is a pheochyomocytoma?
Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much adrenaline and noradrenaline, hormones that control heart rate, metabolism, and blood pressure.
How can renal artery stenosis be treated?
Via angioplasty and stent
What is fibromuscular dysplasia?
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery.
Where can fibromuscular dysplasia be found?
FMD has been found in nearly every arterial bed in the body although the most common arteries affected are the renal and carotid arteries
Who does fibromuscular dysplasia affect?
Young women
What lifestyle advice should you give people about hypertension?
Diet (reduce sodium intake) Weight reduction Exercise Alcohol consumption Smoking
What patient education can be given regarding hypertension?
Info about benefits of drugs and side effects
Details or patient organisations
An annual review of care
What weight loss is recommened for reducing hypertension?
1mmHg for every kg
What decrease in alcohol consumption is recommended for reducing hypertension?
Alcohol reduction should be recommended for the prevention and treatment of hypertension among heavy drinkers
What exercise is recommended for reducing hypertension?
15min/day produces a 14% reduced mortality
What effect does a no salt added diet have to hypertension?
Reduces BP 2-4 mmHg
What are the generic antihypertensives?
Thiazide dieuretics ACE inhibitors ARBs Calcium channel blockers Beta blockers Spironolactone Alpha blockers
What drugs are used in combo for hypertension and angina?
Beta blockers or calcium channel blockers
What drugs are used in combo for hypertension and CCF?
ACE inhibitors and beta blockers
What drugs are used in combo for hypertension and diabetic nephropathy?
ACEI/ARBs
What drugs are used in combo for hypertension and prostatism?
Alpha blockers
What drugs are preferred in treating the elderly for hypertension?
Thiazides
What is the guidelines for anti hypertensive drug treatment for patients under 55?
Step 1= ACEI/ARBs Step 2 = Add CCB Step 3 = Add thiazide-like diuretic Step 4 (resistant hypertension) = Add further diuretic or alpha/beta blocker
What are the guidelines for anti hypertensive drug treatment for patients over 55 or black person of African or Carribbean family origin of any age?
Step 1 = CCB
Step 2 = Add ACE/ARBs
Step 3 = Add diuretic
Step 4 = Consider further diuretic or alpha/beta blocker
Should you add another drug to treatment or titrate higher doses?
Adding a drug is 5x more effective than titrating
What are causes of resistant hypertension?
Non-concordance (not taking the drugs) White coat effect Pseudo-hypertension Lifestyle factors Drug interactions Secondary hypertension True resistance
What is the most effective drug in the treatment of hypertension?
Spironolactone - start low and go slow
Caution with diabetes and low GFR (glomerular filtration rate)
Tolerate a 25% rise in K+ and creatinine
What are the new technologies to treat hypertension?
Renal denervation
Baro-receptor stimulation
Rox Coupler