What is needed to diagnose hypertension?
Clinic BP of ≥ 140/90mmHg with ABPM/HBPM of ≥ 135/85mmHg
What is HBPM and ABPM?
- HBPM = 2 measurements, 1 minute apart, at least 2x a day for ≥ 4 days (7 preferred). Discard day 1 and take an average.
- ABPM = At least 2 measurements per waking hour (normally 14)
What are the definitions of stage 1, stage 2 and severe hypertension?
- Stage 1 = C ≥140/90 A/H ≥135/85
- Stage 2 = C ≥160/100 A/H ≥150/95
- Severe = C ≥180/110 in clinic
What are the targets for BP for different age groups?
- Under 80 = C ≤140/90 A/H ≤135/85
- Over 80 = C ≤150/90 A/H ≤145/85
What are the common causes of secondary hypertension?
ROAR
- Renal Disease
- Obstructive Sleep Apnoea
- Aldosteronism
- Reno-vascular disease
What are some uncommon causes of hypertension?
HICAP
- Hyperparathyroidism (excess PTH)
- Intracranial tumour
- Cushing’s (excess cortisol)
- Aortic coarctation
- Phenochromocytoma (catecholamine-secreting tumour)
Draw the table showing types of hypertension including white coat.
What are the two cardiovascular risk calculators?
- Assign
- UKJBS3
What tests do you offer to those diagnosed with hypertension?
- test urine for presence of protein
- 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 the care pathway for hypertension?
What are the two main risk factors predisposing to hypertension?
- End organ damage
- Established vascular disease
What is the drug pathway for hypertension?
Is there a genetic component involved with hypertension?
Yes - 30-50% genetic
What are the main aspects of treatment of hypertension?
Lifestyle interventions
- Diet, weight exercise
- Smoking
- Alcohol
Drugs
- Education and adherence
- Reviews
Is mono or dual therapy better? Why?
Dual - less side effects. Adding a drug 5x better than titrating up.
When can hypertension be called resistant?
When it cannot be controlled by any drugs - including spironolactone.
How should spironolactone be dosed and what are its contraindications?
Start low, go slow. Watch out for diabetes and kidney damage.
