Hypertension

• Baroreceptors


  • In vessels detect changes in pressure
  • Send messages to brain about whether pressure needs to be higher or lower
• Homeostatic mechanisms controlling BP

  1. Baroreceptors

  2. Sympathetic and parasympathetic regulation

  3. Renin angiotensin aldosterone system
• Essential hypertension


  Caused by things you can control e.g. diet
• Secondary hypertension


  Caused by kidney disease
• Hypertension risk factors


  • Obesity
  • Gender
  • Genetics
  • Job environment
  • High salt diet
  • Stress
  • diet/social history
  • Age
• Hypertension is a risk factor for

  • Angina
  • Stroke
  • MI
  • Kidney disease
  • Dementia
• QRISK3


  Assesses the risk of developing CVD over the next 10 years
• If less than 60 y/o then drug Tx to be considered in those with 10 year CVD risk of <10%
• Everyone with hypertension who has T2DM has ACE I first line irrespective of ethnicity
• If not T2DM but of African Carribean ethnicity then use CBB
• Lifestyle intervention
• Non-pharmacological Tx


  • Diet
  • Exercise
  • Low salt
  • Mindfulness
  • Work
  • Weight reduction
  • Smoking cessation
• QRISK


  Used in primary care to initiate statins→ if risk is over 10% consider starting pt on statin
• Only valid if the pt doesn't already have a diagnosis of heart disease e.g. TIA/MI/Angina
• Encouraged to use QRISK3 as it has more factors that they consider e.g. lupus, dementia
• 20% QRISK3 score


  Means that 20 out of 100 people will have a heart attack or stroke
• Classes of medications


  • ACE Is/ ARBs
  • Calcium Channel Blockers
  • Thiazide Diuretics
  • Spironolactone (Potassium Sparing Diuretic)
  • Alpha Blockers
  • Beta Blockers
• Renin angiotensin aldosterone system

  1. Liver produces angiotensinogen

  2. Renin converts angiotensinogen into angiotensin 1

  3. ACE converts angiotensin 1 to angiotensin 2

  4. Angiotensin 2 increases sympathetic activity, causes the absorption of sodium and also increases aldosterone secretion

  5. Aldosterone secretion causes retention of sodium- which causes water to be retained in the body

  6. Vasoconstriction increases blood pressure
• Side effect of ACE Is

  Dry irritating cough
• ACE Inhibitors & Angiotensin II Receptor Blockers (ARBs)

  • ARB blocks the AT1 receptor, preventing angiotensin II from binding
  • Aldosterone blocker - prevents fluid retention and increase in BP
• S/Es and Titrations and Monitoring for ACE Is and ARBs

  • Dry irritating cough
  • Renal impairment
  • Electrolyte imbalances: Low Na+, high K+ >5
  • Angioedema
  • Dizziness
  • GI Disturbance
  • Altered Taste
• Titration of ACE Is and ARBs

  1. Titrate slowly, every 1-2 weeks

  2. Check U & Es each dose titration

  3. Monitor for renal impairment and changes in potassium levels

  4. Monitor blood pressure and patients symptoms such as hypotension
• Calcium Channel Blockers


  • Calcium channels are blocked, reducing calcium entering cells of heart and blood vessels
  • This causes blood vessels to relax and the heart to receive more oxygenated blood, lowering BP and treating angina
• Non-dihydropyridine CCBs (verapamil & diltiazem)

  • Tend to work on the electrical system of heart as opposed to the arterioles
  • S/E: palpitations, oedema, tachycardia, bradycardia
  • Contraindicated in bradycardia, HF and certain conduction disorders
• Dihydropyridine CCBs


  Main symptom is ankle swelling, especially at higher doses
• STOPP criteria for ALL CCBs: Persistent postural hypotension i.e. recurrent drop in systolic blood pressure more or equal to 20mmHg (risk of syncope and falls)
• Thiazide diuretics


  Help push out sodium which prevents water retention, reducing BP
• Need to know if pt has a history of gout or renal impairment as thiazide diuretics can precipitate gout and are ineffective in severe renal impairment
• One of the S/Es of thiazide diuretics is low potassium