Who wants to be a cardiologist
Hannah
Created on October 4, 2024
Hypertension quiz
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Transcript
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Hypertension
who wants to be a cardiologist?
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Primary hypertension (which occurs in about 90% of people) has no identifiable cause.
Primary versus Secondary Hypertension
Primary hypertension
Secondary hypertension
Secondary hypertension (about 10% of people) has a known underlying cause, such as renal, endocrine, or vascular disorder, or the use of certain drugs.
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Staging Hypertension
NICE GUIDELINES:
Stage 1 hypertension — clinic blood pressure ranging from 140/90 mmHg to 159/99 mmHg 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 of 160/100 mmHg or higher but less than 180/120 mmHg and subsequent ABPM daytime average or HBPM average blood pressure of 150/95 mmHg or higher.Stage 3 or severe hypertension — clinic systolic blood pressure of 180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher.
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Malignant Hypertension
Accelerated (or malignant) hypertension is a severe increase in blood pressure to 180/120 mmHg or higher (and often over 220/120 mmHg) with signs of retinal haemorrhage and/or papilloedema (swelling of the optic nerve).
Referral for same-day specialist assessment should be arranged for people with: A clinic blood pressure of 180/120 mmHg and higher with signs of retinal haemorrhage or papilloedema (accelerated hypertension) or life-threatening symptoms, such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury.
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Diagnosing hypertension
Hypertension should be suspected if clinic systolic blood pressure is sustained above or equal to 140 mmHg, or diastolic blood pressure is sustained above or equal to 90 mmHg, or both. The diagnosis is then confirmed with ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM).
According to NICE:
While waiting for confirmation of a diagnosis of hypertension, the person should be offered:
- Investigations for target organ damage and for secondary causes of hypertension (ECG, fundoscopy, blood glucose, urine dip)
- Assessment of cardiovascular risk (QRISK2)
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QRISK and statins
Statins
Statins are a group of lipid-lowering drugs used to reduce the risk of atherosclerosis and related CVD events.Statins lower blood pressure by cholesterol-independent mechanisms, and the reduction is larger in individuals with higher blood pressure and those with low HDL-C. Statins may be beneficial in preventing hypertension and may contribute to better blood pressure control in hypertensive patients1.
QRISK3
The QRISK score is a tool used to estimate an individual's 10-year risk of developing cardiovascular disease, based on factors like age, cholesterol levels, blood pressure, and lifestyle.
1: Bautista LE. Blood pressure-lowering effects of statins: who benefits? J Hypertens. 2009 Jul;27(7):1478-84. doi: 10.1097/HJH.0b013e32832b1e78. PMID: 19365283.
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- Note: cross-reactivity exists between ACEi and ARBs - seen as the patient is allergic to ACEi, it is more likely for a thiazide-like diuretic to be added rather than an ARB
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