Who wants to be a cardiologist

who wants to be a cardiologist?

Hypertension

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Secondary hypertension (about 10% of people) has a known underlying cause, such as renal, endocrine, or vascular disorder, or the use of certain drugs.

Secondary hypertension

Primary hypertension

Primary versus Secondary Hypertension

Primary hypertension (which occurs in about 90% of people) has no identifiable cause.

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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.

NICE GUIDELINES:

Staging Hypertension

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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.

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).

Malignant Hypertension

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• Investigations for target organ damage and for secondary causes of hypertension (ECG, fundoscopy, blood glucose, urine dip)
• Assessment of cardiovascular risk (QRISK2)

While waiting for confirmation of a diagnosis of hypertension, the person should be offered:

According to NICE:

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).

Diagnosing hypertension

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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.

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.

QRISK3

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.

Statins

QRISK and statins

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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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