Notes in 01_Hypertension

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Published	02/10/2024	{{c1::Hypertension}} is {{c2::the term used to describe high blood pressure >140/90 in clinic or >135/85 with ambulatory or home readings.}}
Published	02/10/2024	Pathophysiology of Hypertension involves a combination of: {{c1::Sympathetic activation (vasoconstriction and increase in total peripheral resistance)…
Published	02/10/2024	Primary hypertension accounts for {{c1::95}}% of hypertension which has developed on its own and does not have a secondary cause.
Published	02/10/2024	Causes of Primary HypertensionThis can be due to a multitude of environmental and genetic factors which involve the following:{{c1::Hypersensitive Sym…
Published	02/10/2024	Explain the role of Hypersensitive Sympathetic Nervous System in Primary Hypertension {{c1::Arteries: Vasoconstriction which leads to an elevation in …
Published	02/10/2024	Explain the role of Hyperactive Renin-Angiotensin-Aldosterone Axis in Primary Hypertension {{c1::A constant increase in the release of Renin stim…
Published	02/10/2024	Explain the role of Low Renin Hypertension in Primary Hypertension {{c1::This is common in the elderly and certain ethnicities where the kidneys …
Published	02/10/2024	Renal Causes of Secondary Hypertension {{c1::Renal artery stenosis (most common)}} {{c1::Vasculitis (e.g. Polyarteritis nodosa, Wegener’s granulo…
Published	02/10/2024	Pregnancy Causes of Secondary Hypertension {{c1::Gestational hypertension is a rise in blood pressure >140/90 without proteinuria during …
Published	02/10/2024	Endocrine Causes of Secondary Hypertension {{c1::Conn’s syndrome (Hyperaldosteronism: remember that aldosterone increases sodium and water r…
Published	02/10/2024	Medication Causes of Secondary Hypertension {{c1::Combined Oral Contraceptive Pill (COCP)}} {{c1::Sympathomimetics (e.g. Adderall, Cocaine)}…
Published	02/10/2024	{{c1::Aortic Coarctation}} is a defect that results in narrowing of part of the aorta which elevates total peripheral resistance as the heart str…
Published	02/10/2024	High Intracranial Pressure (ICP) presents as {{c1::Cushing’s triad}} which involves {{c2::hypertension}}, {{c2::bradycardia}}, and {{c2::irregula…
Published	02/10/2024	Complications of Hypertension {{c1::Left Ventricular Hypertrophy which predisposes to Diastolic heart failure, Ischaemic heart disease, and Arrhythmia…
Published	02/10/2024	Risk Factors of Hypertension {{c1::Smoking and Alcohol}} {{c1::Diabetes mellitus}} {{c1::Obstructive sleep apnoea}} {{c1::Obesity}} {{c1::Renal diseas…
Published	02/10/2024	{{c1::Hypertensive Emergency}} describes {{c2::severely elevated BP >180/120 mmHg with evidence of acute target organ damage (e.g. retinopathy, enc…
Published	02/10/2024	Presentation of {{c2::Malignant Hypertension}} {{c1::Elevated blood pressure (>180/120)}} {{c1::Visual disturbances and retinal haemorrhage}} {{c1:…
Published	02/10/2024	{{c1::Hypertensive Urgency}} describes {{c2::severely elevated BP >180/120 mmHg with NO evidence of acute target organ damage.}}
Published	02/10/2024	{{c1::Gestational hypertension}} is {{c2::high blood pressure (BP >140/90 mmHg) during pregnancy with no proteinuria}}
Published	02/10/2024	{{c1::Pre-eclampsia hypertension}} is {{c2::high blood pressure (BP >140/90 mmHg) during pregnancy from about 20 weeks gestation and proteinuria {&…
Published	02/10/2024	{{c1::White Coat Syndrome}} describes {{c2::the phenomenon where having your blood pressure taken by a doctor or nurse often results in a higher readi…
Published	02/10/2024	{{c1::Masked hypertension}} describes {{c2::a normal blood pressure (BP) in the clinic or office but an elevated blood pressure out of the clinic.}}
Published	02/10/2024	{{c1::Orthostatic hypotension}} describes {{c2::a blood pressure decrease of 20 mmHg systolic and/or a diastolic pressure of 10 mmHg within three minu…
Published	02/10/2024	{{c1::Supine hypertension}} describes {{c2::a blood pressure ≥ 140/90 mmHg that occurs when lying down.}}
Published	02/10/2024	Diagnosis of Hypertension{{c1::Two separate clinic blood pressure reading of >130/90 mmHg}}AND/OR the following:{{c1::Ambulatory blood pressure mon…
Published	02/10/2024	Stages of Hypertension Stage 1: {{c1::Clinic >140/90 + ABPM/HBPM >135/85}} Stage 2: {{c1::Clinic >160/100 + ABPM/HBPM >150/90}} Stage 3: {…
Published	02/10/2024	Renal-Focused Investigations of Secondary Hypertension {{c1::Renal function: U&Es (for eGFR, Creatinine) and Urinalysis (may show haematuria,…
Published	02/10/2024	Endocrine-Focused Investigations of Secondary Hypertension {{c1::Aldosterone to renin ratio (ARR) showing excess aldosterone for suspected Adrenal tum…
Published	02/10/2024	Cardiac-Focused Investigations of Secondary Hypertension {{c1::Brachial-Femoral Delay in Aortic Coarctation}} {{c1::ECHO for signs of heart failu…
Published	02/10/2024	Medication-Focused Investigations of Secondary Hypertension{{c1::Medication Review +/- Urine toxicology (Sympathomimetics e.g. Cocaine and Metham…
Published	02/10/2024	Assessment of End-Organ Damage in Hypertension {{c1::Bloods (HbA1c, renal function and lipid profile)}} {{c1::Urine albumin:creatinine ratio…
Published	02/10/2024	Changes of Hypertensive Retinopathy include {{c1::arteriovenous nipping}}, {{c1::microhaemorrhages and exudates}}, and {{c1::papilloedema}}
Published	02/10/2024	Score used to Assess the Risk of Cardiovascular Disease{{c1::Assign Risk Calculator / QRISK3 (estimate of CV event risk over 10 years)}}
Published	02/10/2024	Conditions that require Rapid Lowering of Blood Pressure{{c1::Aortic Dissection}}{{c1::Ischaemic Stroke}}
Published	02/10/2024	In Aortic Dissection, Systolic BP should be rapidly lowered to a target of between {{c1::100}} to {{c1::120}} mmHg.
Published	02/10/2024	In Ischaemic Stroke, BP should be rapidly lowered in the following cases: {{c1::BP ≥ 185/110 mmHg who are eligible for or who have received thrombolys…
Published	02/10/2024	Approach to Hypertension{{c1::Establish a diagnosis}}{{c1::Investigate for possible causes and end organ damage}}{{c1::Advise on lifestyle}}…
Published	02/10/2024	Lifestyle Advice for Lowering Blood PressureRemembered as {{c1::SWERD}} {{c1::Stop: smoking cessation}} {{c1::Weight: weight reduction (aim for health…
Published	02/10/2024	Commonly Medications Used for HypertensionRemembered as {{c1::ABCD-A}} {{c1::A – ACE inhibitor (e.g. Ramipril)}} {{c1::B – Be…
Published	02/10/2024	Less Commonly Used Medications for Hypertension{{c1::Alpha-adrenoceptor antagonists (e.g. Doxazosin)}}{{c1::Centrally acting agents (e.g. Methyldopa a…
Published	02/10/2024	Stepwise Approach to Hypertension IF ELDERLY (over 55yrs of age) {{c1::Start CCB (If they have T2DM use ACEIs or ARB instead of CCB)}} {{c1::Add Thiaz…
Published	02/10/2024	Stepwise Approach to HypertensionIF YOUNG (below 55yrs of age) {{c1::Start ACEIs or ARBIf female of child bearing age: start CCB (e.g. nifedipine…
Published	02/10/2024	In Hypertension, if the patient is a female of child bearing age, then start {{c1::CCB (e.g. nifedipine)}} or {{c1::Beta Blocker (e.g. labetolol)}} be…
Published	02/10/2024	In Hypertension, if the patient is black of African or African-Caribbean descent, then use {{c1::ARB}} instead of {{c1::ACEis}} due to risk of {{…
Published	02/10/2024	In Hypertension, if the patient is presenting with a {{c1::dry cough}} do not use {{c2::ACEis}}
Published	02/10/2024	In Hypertension, if the serum potassium is {{c1::≤4.5}} mmol/l consider adding {{c2::Potassium-sparing diuretic (e.g. Spironolactone)}}
Published	02/10/2024	In Hypertension, if the serum potassium is {{c1::>4.5}} mmol/l consider adding {{c2::Thiazide diuretic (e.g. Indapamide)}}
Published	02/10/2024	The usage of Potassium-sparing diuretic (e.g. Spironolactone) can be helpful when Thiazide diuretics (e.g. Indapamide) are causing…
Published	02/10/2024	Monitor {{c1::U+Es}} regularly when using ACEis and all Diuretics due to risk of {{c2::hyperkalaemia}}
Published	02/10/2024	When are ARBs used instead of ACEis in Hypertension?{{c1::If patient is black of African or African-Caribbean descent due to risk of angioedema}}{{c1:…
Published	02/10/2024	Antihypertensive Options in Pregnancy {{c1::Beta blocker e.g. Atenolol, Labetalol}} {{c1::Calcium channel blocker e.g. Nifedipine}} {{c1::Less Commonl…
Published	02/10/2024	In Hypertensive Emergency, avoid the usage of the medications {{c1::ACEI}} and {{c1::ARB}} due to risk of  significant renal function damage.
Published	02/10/2024	Non-Pharmacological Treatment of Orthostatic Hypotension {{c1::Repeated rising on the heels (mobilises blood volume)}} {{c1::Isometric handgrips (jump…
Published	02/10/2024	Pharmacological Treatment of Orthostatic Hypotension {{c1::Fludrocortisone acetate}} {{c1::Midodrine}}
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