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WEEK 21:

HYPERTENSION PLENARY

QuestionAnswer
types of hypertension Systemic Hypertension in Adults Hypertension in Pregnancy Hypertension in Renal Disease Pulmonary Hypertension Portal Hypertension Hypertension in Children
definition of hypertension risk factor for cardiovascular disease (modifiable)
less than 80 yrs BP clinic <140/90 APBM/ Home Ave <135/85
more than 80 yrs BP clinic <150/90 APBM/ Home Ave 145/85
stage 1 hypertension clinic blood pressure ranging from 140/90mmHg to 159/99mmHg and subsequent ABPM daytime average or HBPM average blood pressure ranging from 135-85 mmHg to 149/94 mmHg
stage 2 hypertension clinic blood pressure 160/100mmHg or higher but less than 180/120mmHg and subsequent ABPM daytime average of HPM average blood pressure of 150/95mmHg or higher
stage 3 hypertension/ severe hypertension clinic systolic blood pressure of 180mmHg or higher or clinic diastolic blood pressure of 120mmHg or higher
white coat effect discrepancy of more than 20/10mmHg between clinic and daytime average ABPM or average HBPM blood pressure measurements at time of diagnosis
accelerated hypertension severe increase in BP to 180/120mmHg (and often over 220/120mmHg) with signs of retinal haemorrhage and or papilloedema with new or progressive target organ damage (malignant hypertension)
resistant hypertension >3 drugs needed to treat hypertension
genetic factors leading to hypertension liddle's syndrome or gordon's syndrome
environmental factors leading to hypertension overweight and obesity high sodium intake potassium intake (linked to sodium) physical fitness alcohol
korotkoff sound phase 1 systolic pressure
korotkoff sound phase 5 diastolic pressure
in african caribbean descent whaat drugs are effective CCB with either ACE/ CCB with diuretics was better than combination without a CCB
heart attack symptoms chest pain (heavy and squeezing like a vice) SOB sweating nausea and vomiting persisting symptoms
immediate treatment Oxygen IV Analgesia IV Anti-emetic PO Aspirin PO Ticagrelor/Prasugrel
elevated ST AMI/ LV aneurysm/pericarditis/printzmetals
depressed ST ischaemia/LVH with strain/medication/posterior MI
criteria for STEMI Chest pain or cardiac symptoms of an MI in the past 12 hours (or ongoing pain) ST elevation 1mm in 2 contiguous limb leads ST elevation 2 mm in 2 contiguous chest leads
tests for hypertension cardiovascular risk assessment (QRISK3) examine for causes of and for damage from hypertension assess for signs on target organ damage
damage in renal Urine albumin/creatinine ratio (ACR)
damage in heart ECG evidence of Left Ventricular Hypertrophy (LVH)
damage in eyes hypertensive retinopathy
hypertensive retinopathy grades (1-IV) according to keith wagener barker classification I = ‘Silver wiring’ (increased reflectiveness and tortuosity) II = Grade I + AV nipping III = Grade II + Haemorrhage and cotton wool exudates (infarction) IV= Grade III + Papilloedema
secondary causes of hypertension causative medications NSAIDs/ steroids/ OCP etc renal artery stenosis primary hyperaldosteronism (Conn's syndrome) which has low potassium) phaeochromocytoma cushing's syndrome aortic coarctation obstructive sleep apnoea
secondary hypertension unusual (commoner in younger patients with resistant hypertention)
who to refer secondary care emergency referral for accelerated/ malignant hypertension- severe hypertension with grade IV retinopathy and symptoms of stroke chest pain etc routine referral (suspected secondary cause for hypertension less than 40 grade II hypertension etc)
lifestyle modification Low salt diet (<5g per day) Alcohol (<14 units/week) Fruit + vegetables, low red meat. Weight control (BMI<30, waist <102 cm for men , < 88 cm for women) Regular exercise (activity every day, 150 mins moderate exercise) Smoking cessation
how to measure BP Measure in a quiet environment after 5 mins of sitting relaxed, and repeat up to 3 measurements in both arms using the highest result
Created by: kablooey
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