Hypertension

Question 1

Definition
What are the measurements?

Answer 1

Persistently high BP

140/90<mmHg in clinic/hospital
135/85<mmHg at home (ABPM) - Not measured by Dr (white coat syndrome)

Question 2

What is primary hypertension?
Cause?
% of cases?

Answer 2

1^ = essential
Cause = idiopathic
95% of cases (eg. Genetic, diet)

Question 3

What is secondary hypertension?
Cause?
% of cases?

Answer 3

Known underlying cause - 5%
ROPE : Renal eg. CKD (MC of 2^)
Obesity
Pregnancy induced
Endocrine (cushings, CONNs, phoechromocytoma)

Question 4

Stages of hypertension & mmHg in clinic + at home

Answer 4

1: 140/90 135/85
2: 160/100 150/95
3(malignant)= systolic =180+. Diastolic=110+
Can cause organ damage =start treatment immediately

Question 5

Risk factors

Answer 5

Increasing age
Black ethnicity
Overweight
Low exercise
Smoking
Diabetes
Stress
High salt intake
Family history

Question 6

Pathology of hypertension

Answer 6

All mechanisms will increase RAAS & SNS (CO) activity and TPR
Therefore increase BP as BP=CO x TPR

Question 7

Symptoms

Answer 7

Mostly asymptomatic,found on screening
May have pulsatile headaches

Question 8

Malignancy hypertension
What is it marked by?
Typical patient?
Signs and symptoms?

Answer 8

Caused by diastolic (120+) - normally 180-120
Rare but scary
Patient = black male 30-40

Heart failure (LVH)
Blurred vision (papillodema, retinal haemorrhage)
Haematoma + renal failure (glomerulonephritis)
Headache, risk of cerebral haemorrhage

Also consider signs of 2^ cause (phaeochromocytoma, cushings)

Question 9

Diagnosis of Htn

Answer 9

BP reading in hospital 140/90+
Then ABPM (ambulatory BP monitoring) for 24 hours to confirm diagnosis (BP 135/85+ through day)

Question 10

Stage 1 and 2 diagnosis?

Answer 10

Stage 1 - Q risk - treatment
Stage 2 - anti hypertensive treatment

Question 11

How to assess end organ damage?

Answer 11

More damage = worse prognosis
Fundoscopy = papillodema
Urinalysis, eGFR, serum creatine, glucose - renal function
ECHO/ECG - LVH

Question 12

Treatment for Htn

Answer 12

1. <55 or T2DM + non black =ACE-i
   >55 or black = calcium channel blocker
2. ACE-I + CCB

3.ACE-I + CCB + thiazide like diuretic or thiazide

4. All 3 and 4th drug
   If K+ >4.5 = alpha/beta blocker
   If K+ <4.5 = spironolactone (K+ sparing)

Question 13

What do thiazides cause?

Answer 13

Hypokalaemia

Question 14

If a patient has T2DM and is black, what is the course of treatment?

Answer 14

T2DM takes precedence
Take ACE-I

Question 15

Complications of Htn

Answer 15

Heart failure, increased IHD risk, CKD, cerebrovascular accident risk increases