{"id":32,"date":"2017-03-22T11:00:57","date_gmt":"2017-03-22T11:00:51","guid":{"rendered":"http:\/\/papergp.com\/index.php\/health-promotion\/hypertension\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"hypertension","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/cardiovascular\/hypertension\/","title":{"rendered":"Hypertension"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>Data gathering<\/strong><\/h4>\n<ul>\n<li>Red flags\n<ul>\n<li>Visual symptoms, papilloedema, retinal haemorrhages<\/li>\n<li>Chest pain<\/li>\n<li>Headaches<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Examine\n<ul>\n<li>BP, BMI<\/li>\n<li>CV<\/li>\n<li>Fundoscopy<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Clinical management<\/strong><\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>QRISK2<\/li>\n<li>Urine dip\n<ul>\n<li>Red flag if microscopic haematuria<\/li>\n<\/ul>\n<\/li>\n<li>Urinary catecholamines (if young)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>Lifestyle\n<ul>\n<li>Diet (salt), alcohol, smoking, exercise<\/li>\n<\/ul>\n<\/li>\n<li>Medications\n<ul>\n<li>see below<\/li>\n<\/ul>\n<\/li>\n<li>Assess for end-organ damage\n<ul>\n<li>Urine\n<ul>\n<li>dipstick<\/li>\n<li>albumin:creatinine ratio<\/li>\n<\/ul>\n<\/li>\n<li>Bloods\n<ul>\n<li>U+Es, HbA1c, cholesterol<\/li>\n<\/ul>\n<\/li>\n<li>ECG<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Followup \/ Safety net\n<ul>\n<li>Annual bloods, BP<\/li>\n<li>BP targets\n<ul>\n<li>Younger than 80 years old: &lt;140\/90<\/li>\n<li>Older than 80 years old: &lt;150\/90<\/li>\n<\/ul>\n<\/li>\n<li>Refer\n<ul>\n<li>Accelerated hypertension (&gt;180\/110 with fundoscopy signs)<\/li>\n<li>Phaeochromocytoma (headache, palpitations, sweats)<\/li>\n<li>&lt; 40 years old<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Antihypertensive drug treatments<\/strong><\/h4>\n<ul>\n<li>Start if:\n<ul>\n<li>BP &gt; 140\/90 (&gt;150\/90 if over 80 years old) and:\n<ul>\n<li>Target organ damage<\/li>\n<li>QRISK &gt; 10%<\/li>\n<li>Co-morbidities: CKD, DM, known CVD<\/li>\n<\/ul>\n<\/li>\n<li>BP &gt;160\/100<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>&lt; 55 years old or T2DM\n<ul>\n<li>Step 1 ACE-I \/ ARB<\/li>\n<li>Step 2 + CCB<\/li>\n<li>Step 3 + Thiazide<\/li>\n<li>Step 4 + Spironolactone 20mg OD (if K+ &lt; 4.5) OR alpha blocker (Doxazosin) OR beta blocker (Atenolol)<\/li>\n<li>Step 5 Refer<\/li>\n<\/ul>\n<\/li>\n<li>T2DM and black person of African or Caribbean origin\n<ul>\n<li>Step 1 ACE-I \/ ARB + CCB or Thiazide<\/li>\n<\/ul>\n<\/li>\n<li>&gt; 55 years old or black person of African or Caribbean origin\n<ul>\n<li>Step 1 CCB or Thiazide<\/li>\n<li>Steps as above<\/li>\n<\/ul>\n<\/li>\n<li>Examples of drugs\n<ul>\n<li>ACE-I: Ramipril<\/li>\n<li>ARB: Losartan<\/li>\n<li>CCB: Amlodipine<\/li>\n<li>Thiazide: Bendroflumethiazide<\/li>\n<li>Potassium sparing diuretic: Spironolactone<\/li>\n<li>Alpha blocker: Doxazosin<\/li>\n<li>Beta blocker: Atenolol<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Patient under 40 years old with newly diagnosed hypertension<\/strong><\/h4>\n<ul>\n<li>Differential diagnosis\n<ul>\n<li>Structural\n<ul>\n<li>Renal artery stenosis<\/li>\n<li>Coarctation<\/li>\n<\/ul>\n<\/li>\n<li>Metabolic\n<ul>\n<li>Phaeochromocytoma<\/li>\n<li>Conns &#8211; Primary hyperaldosteronism<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Investigations\n<ul>\n<li>Bloods &#8211; FBC, U+E, LFTs, Fasting glucose, TFTs, Lipids<\/li>\n<li>Urine &#8211; dipstick<\/li>\n<li>Ultrasound KUB<\/li>\n<li>24hour urine metanephrines<\/li>\n<\/ul>\n<\/li>\n<li>Management\n<ul>\n<li>Refer to speciality based on cause<\/li>\n<\/ul>\n<\/li>\n<li>Note\n<ul>\n<li>10-year CV risk assessments can underestimate the lifetime risk of CV events in this group<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Reference<\/strong><\/h4>\n<ul>\n<li><a href=\"https:\/\/gps.camdenccg.nhs.uk\/pathways\/hypertension\">Camden CCG Hypertension pathway<\/a><\/li>\n<li><a href=\"https:\/\/patient.info\/doctor\/hypertension#nav-6\">Patient.info Hypertension Professional article<\/a><\/li>\n<\/ul>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Data gathering Red flags Visual symptoms, papilloedema, retinal haemorrhages Chest pain Headaches Examine BP, BMI CV Fundoscopy Clinical management Investigations QRISK2 Urine dip Red flag if microscopic haematuria Urinary catecholamines (if young) Treatment Lifestyle Diet (salt), alcohol, smoking, exercise Medications see below Assess for end-organ damage Urine dipstick albumin:creatinine ratio Bloods U+Es, HbA1c, cholesterol ECG &hellip; <a href=\"https:\/\/papergp.com\/index.php\/cardiovascular\/hypertension\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Hypertension<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":284,"menu_order":49,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-32","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/32","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=32"}],"version-history":[{"count":16,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/32\/revisions"}],"predecessor-version":[{"id":2432,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/32\/revisions\/2432"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/284"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=32"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}