Definition of HTN and Primary vs Secondary
Persistantly raised arterial blood pressure (above 140/90)
Primary - no identifiable cause
Secondary - known underlying cause such as renal, endocrine, vascular, drugs
Classification of Hypertension
Stage 1 : Clinic - 140/90 and HBPM 135/85-149/94
Stage 2: Clinic - 160/100-180/120 and HBPM 150/95 or higher
Stage 3: Clinic - 180/120 or highr
Risk Factors - 7
- Older age
- gender up to 65, males have higher. After 65, women have higher
- Ethnicity - black african and caribbean
- FH
- Social deprivation
- Lifestyle - smoking, alcohol, salt, obesity
- anxiety and emotional stress
Secondary Causes of HTN - 9
- CKD (most common)
- Other renal disorders
- Renal artery stenosis
- Coarctation of aorta (congential narrowing)
- Hyperaldosteronsim
- Cushings
- Hypo or hyper thyroidism
- Drugs
- Pregnancy
Which drugs may cause HTN - 7
- alcohol
- Ciclosporin
- cocain
- COCP
- Corticosteroids
- NSAIDs
- Oestrogen in HRT
Complications of HTN - 6
- heart failure
- Stroke
- ACS
- CKD
- Peripheral arterial disease
- vascular dementia
Investigations of HTN - 4
Assess for end-organ damage:
- urine dip and ACR (for CKD)
- HbA1c (for diabetes)
- fundoscopy to test for retinopathy
- ECG to detect for LV hypertrophy
Lifestyle management of HTN - 5
- weight loss
- dietary modifications
- minimized alcohol and caffiene intake
- stress reduction
- smoking cessation
Pharmacological Management of HTN - 4 steps
- if <55 ACE inhibitor or ARB if not tolerated. If >55 or african/caribbean, CCB
- CCB and ACEi/ARB combination
- ACEi/ARB and CCB and T-like diuretic combination
- If hypokalaemic - add Spironolactone or B blockers. If hyperkalaemic - increase T-like diuretic dose
ACE Inhibitors - examples, MOA and ADRs (4)
- Ramipril and Lisinopril
- Blocks ACE so less ang II produced
- Hypotension, dry cough, hyperkalemia, angioedema
Angiotensin II Receptor Blockers - examples, MOA and ADRs (3)
- Candestartan and losartan
- Blocks AT1 and 2 receptors
- Hypotension, hyperkalaemia, renal failure
CCB 1 (Dihydropyridines) - examples, MOA and ADRs (4)
- Amplodipine and nimodipine
- Blocks calcium channels in the peripheral vasculature so stops SM contraction
- Peripheral oedema, flushing, headaches, palpitations
CCB 2 (phenylalkylamine) - examples, MOA and ADRs (3)
- Verapamil
- blocks CCs specifically in cardiac tissues and cerebrally
- constipation, bradycardia, heart block
Thiazide-like diuretic - examples, MOA and ADRs (4)
- Indapemide
- Inhibits Na+ reabsorption through Na/Cl transporter at the DCT
- Hyperuricaemia, hyperglycaemia, ED, hypokalaemia
Spironolactone - MOA and ADRs (2)
- Blocks aldosterone receptors at the DCT, so less ENAC and ROMK expressed - less
- Hyperkalaemia and gynaecomastia
Beta Blockers - examples, MOA and ADRs (4)
- Bisoprolol and metoprolol
- Blocks neuradrenaline so reduces SNS, reduces myocardial contraction, reduces CO
- Bronchospasm, heart block, raynauds, ED
