Hypertension
Definition
NOTE: Normal BP dips at night. Non-dipper = likely risk of postural hypotension
- SBP rises with age
- Benefits of treatment outweights risks/ hazards
NOTE: Normal BP dips at night. Non-dipper = likely risk of postural hypotension
Aetiology
NOTE: little evidence that stress causes hypertension
- 95% essential htn (no cause)
- others: see below
- Genetics (40-60%) - higher risk = african americans, japanese
- Environmental (eg diet)
NOTE: little evidence that stress causes hypertension
Clinical Features
Signs
Diagnosis
2 measurements 5 min apart, consider 24h ambulatory monitoring/ home BP monitoring (white coat htn). If constantly elevated, diagnose as htn
Investigations
Bedside: Urinalysis (renal), ECG
Bloods: UEC, lipids, blood glucose, TFT
Management
Non pharm: SNAP
Pharm:
Signs
- Radio-femoral delay (coarctation of aorta)
- Abdo bruits (renal a stenosis)
- Enlarged kidneys (PCKD)
- Cushing's signs
- Apical heave (LVH)
- Bounding pulse, carotid bruits (atherosclerosis)
Diagnosis
2 measurements 5 min apart, consider 24h ambulatory monitoring/ home BP monitoring (white coat htn). If constantly elevated, diagnose as htn
Investigations
Bedside: Urinalysis (renal), ECG
Bloods: UEC, lipids, blood glucose, TFT
Management
Non pharm: SNAP
Pharm:
NOTE: BB has weaker evidence base, may be used with co-morbidities eg. angina/ heart failure
NOTE: Do not give CCB if HR >85 due sefx tachycardia
Complications
Source
Davidson's 22nd Ed 2014
Dr Editha Miguel 2014
NOTE: Do not give CCB if HR >85 due sefx tachycardia
Complications
- Stroke*
- Coronary artery disease*
- Hypertensive retinopathy
- Malignant hypertension
- Renal failure
Source
Davidson's 22nd Ed 2014
Dr Editha Miguel 2014