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Flashcards in Hypertension Deck (59)
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1

what signs and symptoms of hypertension

end organ damage

2

What are the three stages of hypertension

Stage 1
- 140/90 and ABPM 135/85

Stage 2
- 160/100 and ABPM 150/95

Stage 3
- Systolic> 180 or diastolic >110

3

ABPM what does it stand for

ambulatory blood pressure mean - get a day time mean and and a night time mean - the figure is for the day time mean

4

How do you measure postural hypotension

- Measure BP seated or supine
- Stand the patient for 1 minute
- Systolic drops by more than 20mm

5

What is the definition of postural hypotension

- this is when systolic drops by more than 20mm

6

What is the definition of malignant hypertension

- BP > 180/110 AND signs of papilloedema or retinal haemorrages

7

Describe how a ABPM work

- 24 hr monitoring

Machine size of half a BNF
- Take BP 3 times an hour during the day and hourly at night
- BP should dip at night; if not worse prognosis

8

in ABPM what should drop at night

BP should dip at night; if not worse prognosis

9

guidelines suggests that all patients should have a

ABPM before treatment

10

What is the alternative to ABPM

- Week of home blood pressure monitoring and then ask them to average it out

11

How should you take a history

CO

HPC
- Ask about pregnancy and the pill
- Ever had a BP check at work or for work eg HGV

PMH
- Diabetes
- CVA
- MI
- Renal disease

FH
- Cause and age of death
- Specifically ask about MI and CVA
- Parents and siblings

SH
- Smoking
- Alcohol
- Salt
- Dairy
- 5 a day
- Exercise
- Caffeine
- snoring

12

What should you look for in systems review for hypertension

- Cardiovascular
- Angina
- Claudication
- Exercise tolerance
- Erectile function

Females
- Pregnancy plans /contraception

13

How do you examine a patient with blood pressure

- Measure BP in both arms
- APBM before starting treatment

Look for end organ damage
- eyes
- urine - proteinuria

Look for secondary causes
- cushings
- coarctation
- renal artery stenosis

14

What does coarctation look like

Between the two arms
radial delay

15

What investigations can you use

- ABPM
- Urinalysis - for protein, albumin:creatine ratio and haematuira

U&E
- Conns
- hyperparathyroidism

Blood tests
- glucose
- electrolytes
- creatine
- eGFR
- total and HDL cholesterol

- Fundoscopy - check for retinopathy

- ECG - check for left ventricular hypertrophy


Secondary care
- ECHO
- Urinary Metanephrines
- Renin/aldo ratio (Conns)
- Renal/liver ultrasound

16

What are the two things can can effect measurement of blood pressure not due to hypertension

- Wrong cuff size - lead to wrong measurement
- White coat - doctors make patients anxious - picked up on ABPM
- masked hypertension - relaxed when they see the doctor but BP is high the other time - picked up on ABPM

17

What can cause essential hypertension

Genetic

Environmental
- City living
- Alcohol
- Obesity
- Salt
- Lack of exercise
- OSA - obstructive sleep apnea

18

What causes secondary hypertension

- Phaeochromocytoma
- Cushings
- OSA
- Obesity
- Conns
- Renal disease
- Renal artery stenosis

Drugs
- OC
- Steroids
- Recreational drugs e.g. cocaine

19

What type of end organ damage presents in hypertension

Heart
- MI
- CCF

Brain
- CVA

Kidney
- Nephrosclerosis
- Accelerates other forms of kidney disease

Depends on ethnicity

Legs

Erectile function

20

How do you manage stage 1 hypertension

Assess cardiovascular risk
- If target organ damage or 10% over 10 yrs risk give drugs
- Younger adults; consider drug treatment at a lower risk
- Life style intervention

21

How do you manage stage 2 hypertension

- Check with ABPM
- Drugs and lifestyle

22

How do you manage stage 3 hypertension

- Treat now with drugs
- then do an ABPM
- then recommend lifestyle

23

Describe what medications to give to what patients

Younger than 55
Step 1
- ACE 1st
Step 2
- ACE + CCB or ACE + Thiazide type diruetics
Step 3
- ACE + CCB + Thiazide like diuretics
step 4
- add a further direutics
or
- alpha blocker
or
- beta blocker
and consult specialist advice

Older than 55 or afro-carrabean or black patients of any age
Step 1
- CCB or Thiazide
Step 2
- ACE + CCB or ACE + thiazide
Step 3
- ACE + CCB + Thiazide
Step 4
- add a further direutics
or
- alpha blocker
or
- beta blocker
and consult specialist advice

24

Why do black and Afro-Caribbean patients not respond to ACE inhibitors

- They have lower plasmin renin therefore something that acts on the RAAS it is less effective
- but if you stimulate the RAAS you raise the renin aldosterone levels and they become sensitive to the ACE

25

Describe what you should check before you prescribe an ACE

- Check pregnancy plans (can be tetrogenic)
- Under 55
- Not as monotherapy in Africans or Caribbean

26

Who should you give CCBs to

- over 55
- African or Caribbeans

27

What can be contradicted in calcium channel blockers

- Can cause ankle swelling - therefore caution if worried about heart failure or oedema

28

Name the types of calcium channel blockers

- Verapamil
- Dilitiazem

Dihydropyridines
- Amlodipine (common)
- nifedepine (in pregnancy and breast feeding)
- lacidipine (less ankle oedema)

29

Name a side effect of calcium channel blockers

- All cause gum hyperplasia - good dental hygiene is needed
- can cause ankle oedema

30

Name some examples of a loop diuretics

- Bumetanide
- Furosemide