Classification
What is Stage 1 hypertension?
A clinic blood pressure of 140/90 mmHg or higher
A subsequent Ambulatory (ABPM) or Home (HBPM) daytime average of 135/85 mmHg or higher.
What is essential (or primary) hypertension?
Cause of 90-95% of hypertensive cases where the cause is idiopathic
Why is hypertension referred to as the "silent killer"?
The most common clinical presentation is it being asymptomatic and why screening is important despite patients being healthy.
Give 3 lifestyle changes to help a patient lower their blood pressure
Reduce salt intake
Loss excess weight
Exercise regularly
Manage stress and sleep
Limit alcohol
Adopt healthy diet
What is amlodipine?
Calcium channel blocker (CCBD) - first line for patients aged 55 or over, or patients of Black African or African-Caribbean family origin of any age (without T2D)
What is stage 2 hypertension?
Clinical BP of 160/100 mmHg
ABPM or HBPM of average 150/95 mmHg or higher
What is Conn's syndrome?
Primary hyperaldosteronism
The most common endocrine cause of secondary hypertension, typically caused by an adrenal adenoma or bilateral adrenal hyperplasia. Presents with hypokalaemia
Give 3 symptoms associated with hypertension
Headache (typically occipital and worse in the morning)
Shortness of breath
Dizziness
Chest pain
Nose bleed
Palpitations
What is an Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM)?
ABPM involves wearing portable monitor and arm cuff to automatically record blood pressure over 24 hour period, every 15-30 minutes.
HBPM involves taking your own blood pressure manually or automatically, usually twice a day, for several days to a week.
What is ramipril and losartan?
ACE inhibitor / ARB
First line for patients aged under 55 (of non-Black African/African-Caribbean origin) OR any patient with T2D regardless of age or ethnicity
What is stage 3 (or severe) hypertesnion?
A clinical systolic blood pressure of 180 mmHg or higher, OR a clinical diastolic blood pressure of 120 mmHg or higher
What is the most common secondary cause of hypertension?
Renal diseases
Examples include CKD, PKD, diabetic nephropathy.
What are sign/s of hypertension on fundoscopy?
Cotton-wool spots, hard exudates, haemorrhages, papilloedema
What is a formal cardiovascular risk assessment that can be used?
QRISK3 - used to estimate an individual's % risk of developing a cardiovascular disease (heart attack or stroke) within the next 10 years.
<10% is usually low risk.
More than >10% consider both lifestyle choices and statin
What is the standard dual-therapy regiment recommended by NICE if a patient's blood pressure remains uncontrolled on monotherapy?
ACEi/ARB combined with CCB or a thiazide-like diuretic
What is a same-day emergency specialist referral (hypertensive emergency)?
Immediate clinical action required for a patient with a clinical blood pressure of equal to or more than 180/120 mmHg presenting with signs of new or progressive damage to vital organs e.g. retinal haemorrhage/papilloedema, chest pain, confusion, or acute kidney injury.
What is the likely diagnosis in a patient with refractory hypertension with upper-limb hypertension and a suprasternal murmur radiating through the back
Coarctation of the aorta - narrowing of the aorta causing high blood pressure in the upper body and restricted flow to the lower half. BP can differ from arm to arm
Primary treatment options include surgery repair and balloon angioplasty
What are the classic triad of symptoms for phaeochromocytoma?
Rare neuroendocrine tumour suspected in patient with severe hypertension with a clinical triad of episodic headache, palpitations, and diaphoresis (sweating)
What class of diuretics are typically used as first-line for hypertension?
Thiazide diuretics e.g. indapamide
Loop are usually not first-line for uncomplicated hypertension, reserved for patients with severe kidney disease or fluid retention
What is the likely diagnosis in a young woman with recurrent headaches, significant hypertension, and a carotid systolic bruit?
Fibromuscular dysplasia - non-inflammatory and non-atherosclerotic condition involving abnormal growth in arteries including renal, carotid and vertebral arteries, which restrictss blood flow.
Management = antihypertensive meds and surgery or PTA
nb: >90% of cases in women. Cause unknown - hormone, genetics?