Hypertension

Hypertension

Jun 7, 2014 0
cardiology,endocrinology,General medicine,onthepods,renal

James chats with Dr John Saunders, Renal Physician about some of the common issues with hypertension, or high blood pressure, on the wards.

Editor:  James Edwards

Interviewee:  John Saunders

Hypertension on the wards

with Dr John Saunders, Renal Physician at Royal Prince Alfred Hospital, New South Wales, Australia

  • Are they symptomatic?
  • Ensure BP reading is real (do a manual)
  • Look at trend of BP
  • Check for signs of pulmonary oedema, chest pain, headache, neurological function, affected vision
  • Check comorbidities – renal disease, heart failure
  • Guided by the patient’s clinical status
  • Give usual medications if they have been missed
  • Use small doses of short acting agents like hydralazine or clonidine
  • GTN patches cause headache and are ineffective at lowering BP (except in heart failure or angina)
  • Long acting agents like amlodipine are more appropriate in the long term management
  • Manage the patient, not the number.
  • Hypertension is really common. Work out if it’s a big change from normal.
  • Think about the cause of the hypertension. (Missed medication? Pain?)
  • Be careful in special groups – pregnant women, intracerebral bleeding, stroke, neurosurgical situations.
  • If the patient looks well and is asymptomatic, there may not be a need to treat the hypertension.
  • Always consult a more senior person (e.g. medical registrar) before instituting treatment.

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Tags: #blood pressure,#cardiac disease,#cardiology,#high blood pressure,#hypertension,#metabolic syndrome

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