”

Hypertension
“the silent killer”

Angela MacAdam
a.macadam@brighton.ac.uk

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 This lecture…..

•Case team
•The patient
•Terminology
•Definitions
•Risk

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Case team
Mark Yeoman Matt Ingram
(case leader) M.J.Ingram@brighton.ac.uk
M.S.Yeoman@brighton.ac.uk
Sian Williams
Angela MacAdam sew13@brighton.ac.uk
A.Macadam@brighton.ac.uk
Alison Warren
Alison.Warren@bsuh.nhs.uk

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 The patient
Mr Holmbush is a 65 year old accountant.

He presents to his GP for a routine health check.

However on examination his blood pressure is

raised and the GP subsequently diagnoses
hypertension.

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Terminology
• Hypertension
– “High blood pressure”
• Cardiovascular disease (CVD)
– Includes all the diseases of the heart and blood
vessels
• Cardiovascular risk
– The likelihood of developing angina, myocardial
infarction or stroke

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Hypertension
One of the most important preventable causes
of premature morbidity and mortality in the
UK.

Management is one of the most common

interventions in primary care.

£2 billion – cost of hypertension to NHS

Public Health England (2014) https://www.gov.uk/government/news/new-figures-show-high-
blood-pressure-costs-nhs-billions-each-year

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 When does normal BP end and high BP
begin?

Need to define hypertension because of

morbidity associated if remains
uncontrolled.

16 million people in UK have BP>140/90 =

30% of the population
Bloodpressureuk.org

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Blood pressure is the force of the blood pushing
against the walls of the arteries.

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Systolic / diastolic

• Effects of Hypertension

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Definitions
• Essential / primary 90-95%
– No identifiable cause
– Mild-moderate elevation in BP

• Secondary 5-10%
– Cause identified
– Often rapid progression with very high BP
• Renal disease
• Adrenal gland disorders
• Hyperthyroidism
• Drugs*

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Why treat hypertension?
Each increment of 2mmHg SBP increases risk
of mortality by up to 10%

Increased risk of heart failure, myocardial

ischaemia, stroke and renal failure...

Each reduction of SBP by 6mmHg reduces

CVA risk by 40%

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

Left ventricular hypertrophy
Left ventricular hypertrophy is a thickening of the wall of the heart's main pumping chamber.
This thickening may result in elevation of pressure within the heart and sometimes poor
pumping action. The most common cause is high blood pressure.
PY267 Intermediate Pharmacy 3 Case 10 Hypertension
 Organ damage
Organ Damage
Heart (cardiovascular) LVH / Heart failure
Myocardial ischaemia
Brain (Cerebrovascular) Stroke
Aorta and peripheral vascular Aortic aneurysm
Arteriosclerosis
Kidney (Renal) Nephrosclerosis
Renal failure
Eyes (Retina) Haemorrhages
Papilloedema

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

PY267 Intermediate Pharmacy 3 Case 10 Hypertension
 Who is at risk?
Risk increases with age, but also if you;
• are overweight
• have a relative with high blood pressure
• smoke
• are of African or Caribbean descent
• eat too much salt
• don't eat enough fruit and vegetables
• don't do enough exercise
• drink too much coffee (or other caffeine-based drinks)
• drink too much alcohol

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Risk factors for CVD
Non-modifiable Modifiable

• Family history • Hyperlipidaemia

(male age <55 / Female <65) • Smoking
Stop smoking for 10 years ≡ never smoked

• Age • Hypertension
• Diabetes mellitus
• Gender • Personality
• Abdominal obesity
PY267 Intermediate Pharmacy 3 Case 10 Hypertension
 QRISK®2-2017 risk calculator
• Calibrated for UK population
• Calculates risk of having a ‘heart attack or
stroke’ over the next ten years
• Based on data from GPs, it is updated annually
each April, to remain as accurate as possible.
• Remember this is for a primary prevention
patient
– https://qrisk.org/2017/

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

PY267 Intermediate Pharmacy 3 Case 10 Hypertension
PY267 Intermediate Pharmacy 3 Case 10 Hypertension
 The patient
Mr Holmbush is a 65 year old accountant.

He presents to his GP for a routine health check.

However on examination his blood pressure is

raised and the GP subsequently diagnoses
hypertension.

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 SAQ
Mrs E is a 52 year-old lady who has been diagnosed
with hypertension with no other complications.

What would be the 1st line treatment for this patient?

What monitoring should be performed before starting
a patient the treatment? (5 marks)

PY267 Intermediate Pharmacy 3 Case 10 Hypertension

 Questions?

PY267 Intermediate Pharmacy 3 Case 10 Hypertension