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Hypertension (Risk factors (Age - risk increases as you age, Race -…
Hypertension
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Treatment
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ACD pathway
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Beta blocker is NOT the first line treatment - consider in young people especially if intolerant to ACEi/ARB
Less than 55 years old
- Ramipril/candesartan
- Then add Nifedipine
- Then add Bendoflumethiazide
- Then add Furosemide
Older than 55 years old/African-Caribbean origin
- Ramipril/Candesartan + Nifedipine
- Then add Bendroflumethiazide
- Then add Furosemide
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Diagnosis
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Urinalysis
For protein, albumin:creatine ratio and haematuria
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Look for end-organ damage e.g. left ventricular hypertrophy, retinopathy, and proteinuria - indicates severity and duration of hypertension and associated with a poorer prognosis
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Epidemiology
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Remain under diagnosed, under treated and poorly controlled in the UK
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The commonest cause of cardiac failure and a major risk factor for atherosclerosis and cerebral haemorrhage
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Definition
Hypertension is a major cause of premature vascular disease, leading to cerebrovascular events, ischaemic heart disease and peripheral vascular disease
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Hypertension values
Severe hypertension
Clinic systolic BP greater than or equal to 180mmHg and/or diastolic BP greater than or equal to 110 mmHg
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Stage 1 hypertension
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Daytime average Ambulatory blood pressure monitoring (ABPM - 24 hr BP monitor) or Home blood pressure monitoring (HBPM); greater than or equal to 135/85mmHg
Classification
Done according to whether the cause is unknown (essential (primary or idiopathic) hypertension) or is known (secondary hypertension)
Secondary causes include
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Endocrine causes e.g. Cushing's, Conn's
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