Hypertension: Difference between revisions

From MedRevise
Jump to navigation Jump to search
 
(17 intermediate revisions by 2 users not shown)
Line 1: Line 1:
===Definition===
===What is Hypertension===
High blood pressure. According to NICE, it has to be persistenly over 140/90mmHg.
'''Hypertension is high [[blood pressure]]'''. It's the opposite of [[hypotension]].
===Epidemiology===
Ridiculously high prevalence - 11.3%.  95% is primary (i.e. no known cause).
===Pathophysiology===
There are two types :
*'''essential''' (aka ''primary'' or ''systemic'') - it just happens and nobody knows the cause.
*'''secondary''' - caused by another disease.


===Risks===
===What types are there?===
====Risk Factors====
There are two types of hypertension:
Nobody knows the exact cause of hypertension but there are some risk factors:
*Diet - high salt, calcium and coffee intake
*[[Genetics]]
*[[Oral contraceptive]]
*[[HRT]]


====Associated Risks====
*[[Essential hypertension]] - which is caused by, well, nobody's sure.
Hypertension is massively associated with [[cardiovascular]] disease which is why it is so important. It increase the risk of:
*[[Secondary hypertension]] - which is caused by something else.
*[[stroke]]
*[[ischaemic heart disease]]
*[[left ventricular hypertrophy]] and [[cardiac failure]]


 
Excluding the second of these is important because it's often incredibly serious (like [[renal failure]] or something).
===Clinical Features===
The main clinical feature of high blood pressure is high blood pressure. Go figure. Well, I'm sure you did. This is about excluding [[secondary hypertension]].
 
====Classification====
 
 
{| border="1"
|-
!Category
!Systolic blood pressure (SBP)
!Diastolic blood pressure (DBP)
|-
|''Normal''
|
|
|-
|Optimal
|<120
|<80
|-
|Normal
|<130
|<85
|-
|High normal
|130-139
|85-89
|-
|''Hypertension''
|
|
|-
|Mild (grade 1)
|140-159
|90-99
|-
|Moderate (grade 2)
|160-179
|100-109
|-
|Severe (grade 3)
|>/=180
|>/=110
|}
 
Obviously, in most patients, looking to get the BP to normal is what you aim for. However, there are certain populations where you need to aim lower. Check this shit!
 
{| border="1"
|-
|
!SBP
!DBP
|-
!Diabetes - ''no nephropathy''
|
|
|-
|Intervention threshold
|140
|90
|-
|Target levels
|130
|80
|-
!Diabetes - ''with nephropathy''
|
|
|-
|Target levels
|130
|80
|-
|Proteinuria (<1g/24h protein in urine)
|125
|75
|-
!Renal disease
|
|
|-
|Intervention threshold
|140
|90
|-
|Target
|130
|80
|-
|Chronic renal disease/proteinuria (see above)
|125
|75
|}
 
===Investigations===
These are more appropriate if [[secondary hypertension]] is suspected. I'd look at the [[secondary hypertension]] page if I were you.
 
===Management===
[[NICE]] and the [http://www.bhsoc.org/ British Hypertension Society]] (BHS) each came up with a set of guidelines regarding the management of hypertension. They came up with the algorithm on the right.
[[image:niceguidelines.gif|right|thumb|400px|<font color=red>A=ACE Inhibitors</font>; <font color=steelblue>C=Calcium-Channel Blocker</font>; and <font color=green>D=Thiazide Diuretic</font>]]
 
Hopefully, when to use <font color=red>ACE inhibitors</font> (ramipril, lisonipril, enalapril), <font color=steelblue>calcium-channel blockers</font> (amlodipine, felodipine, nifedipine) and <font color=green>thiazide diuretics</font> (usu. bendroflumethiazide) is obvious from the incredibly professionally drawn flow chart. Under the "other crazy stuff" moniker we have things like:
*Beta blockers - (atenolol, propanolol, bisoprolol)
*

Latest revision as of 06:11, 5 April 2013

What is Hypertension

Hypertension is high blood pressure. It's the opposite of hypotension.

What types are there?

There are two types of hypertension:

Excluding the second of these is important because it's often incredibly serious (like renal failure or something).