hypertension

Question 1

hypertension isnt a disease what is it?

Answer 1

it is a risk factor for other disease states such as MI, HF, stroke, CKD ,PVD

Question 2

if a patient had HPT but no est CVD how are they treated?

Answer 2

they are treated as primary
prevention rather than secondary prevention.

Question 3

what are the most powerful risk predictors of absolute cardiovascular risk?

Answer 3

logical changes, such as left ventricular hypertrophy and renal impairment but many factors including increasing blood pressure and lipids, smoking, and male sex interact to determine absolute risk.

Question 4

give some examples of possible secondary hypertension cause

Answer 4

renal artery stenosis
coartation of aorta
cushing’s syndrome
drug induced

Question 5

what are the important points to remember when taking a blood pressure?

Answer 5

• Check for pulse irregularity and if present measure
  manually
• Standardisethe environment
• Use appropriate cuff size for patient’s arm

Question 6

what should you do when taking a blood pressure in a person with symptoms of postural hypotension?

Answer 6

–measure blood pressure with the person either
supine or seated
–measure blood pressure again with the person
standing for at least 1minute before
measurement

Question 7

what should you do if blood pressure measured in the clinic is 140/90 mmHg or higher?

Answer 7

– Take a second measurement during the consultation.
– If the second measurement is substantially different from the
first, take a third measurement.
Record the lower of the last 2 measurements as the clinic
blood pressure.

Question 8

if clinical blood pressure is between 140/90 and 180/120 what should you do to confirm diagnosis?

Answer 8

offer ambulatory blood pressure monitoring
(ABPM) to confirm the diagnosis of hypertension

Question 9

what if a ABPM is unsuitable/ unable to tolerate?

Answer 9

offer home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension

Question 10

when would you confirm a diagnosis of HPT ?

Answer 10

in people with a:
– clinic blood pressure of 140/90 mmHg or higher and
– ABPM daytime average or HBPM average of 135/85 mmHg
or higher.

Question 11

how often should you measure a persons BP with diabetes?

Answer 11

at least annually- type 2
offer lifestyle

Question 12

what is the target BP for someone aged 70/80?

Answer 12

80+ 150/90
less than 80 but with underlying condition= 135/85

Question 13

what do you offer to all people with hypertension to assess CVD risk and target organ damage?

Answer 13

• Test for the presence of protein in the urine by sending a urine
  sample for estimation of the albumin: creatinine ratio and test for
  haematuriausing a reagent strip
• Take a blood sample to measure glycated haemoglobin(HbA1C),
  electrolytes, creatinine, estimated glomerular filtration rate, total
  cholesterol and HDL cholesterol
• examine the fundi for the presence of hypertensive retinopathy
• arrange for a 12-lead electrocardiograph to be performed

Question 14

what would you do if a person has severe hypertension 180/120 but no symptoms or signs indicating same- day referal?

Answer 14

carry out investigations for target
organ damage as soon as possible:
– If target organ damage is identified, consider starting antihypertensive drug treatment immediately, without waiting for the results of ABPM or HBPM.
– If no target organ damage is identified, repeat clinic blood pressure measurement within 7days.

Question 15

when do you refer 180/120?

Answer 15

– signs of retinal haemorrhageor papilloedemaor
– life-threatening symptoms such as new onset confusion,
chest pain, signs of heart failure, or acute kidney injury

Question 16

what may suggest phaeochromocytoma?

Answer 16

labile or postural hypotension, headache,
palpitations, pallor, abdominal pain or diaphoresis

Question 17

define est cvd

Answer 17

• Past medical history of stroke or transient
  ischemic attack, heart attack, angina,
  narrowed peripheral arteries

Question 18

who should you discuss starting antihypertensive treatment to?

Answer 18

adults aged under 80 with persistent stage1
hypertension who have 1 or more of the following:
– target organ damage
– established cardiovascular disease
– renal disease
– diabetes
– an estimated 10-year risk of cardiovascular disease of 10% or more
– Use clinical judgement for people with frailty or
multimorbidity

Question 19

what is target blood pressure for over and under 80?

Answer 19

• Age <80 years:
• Clinic BP <140/90 mmHg
• ABPM/HBPM <135/85
  mmHg
• Age ≥80 years:
• Clinic BP <150/90 mmHg
• ABPM/HBPM <145/85
  mmHg

Question 20

what is the bp targets for people with CKD and diabetes?

Answer 20

70mg/mmol or more, aim to keep the systolic blood pressure below 130mmHg (target range 120–129mmHg) and the diastolic blood pressure below 80mmHg

Question 21

what is BP targets for type 1 diabetics?

Answer 21

135/85mmHg unless the adult with
type1 diabetes has albuminuria or 2or more features of metabolic syndrome, in which case it should be 130/80mmHg

Question 22

what is first line for hypertension with T2 diabetes?

Answer 22

ACEi/ ARB

Question 23

what is first line treatment for HPT without t2 diabetes?

Answer 23

CCB
if over 55 and not black- ACEi/ARB

Question 24

what is second line treatment for HPT?

Answer 24

diabetes/ 55+ and not black/ caribbean- ACEI or ARB AND CCB or thiazide diuretic

Question 25

what is second line treatment for 55+ and black people?

Answer 25

CCB
AND
ACEi/ arb or thiazide diuretic

Question 26

what follow ups are needed with HPT?

Answer 26

• When starting drug treatment:
  –Recheck BP every 4 weeks.
• If starting a thiazide (like) diuretic:
  –Check urea and electrolytes, and the eGFR at
  baseline and every 4-6 weeks.
• If starting an ACE inhibitor or an AIIRA:
  –Check urea and electrolytes, and the eGFR at
  baseline and 1-2 weeks after starting treatment.
• If starting a CCB no specific blood tests are
  required.