Cardiology - Hypertension

Question 1

What are some secondary causes of hypertension?

Answer 1

ROPED

Renal disease
Obesity
Pregnancy- induced hypertension or pre-eclampsia
Endocrine
Drugs

If under 40, consider specialist investigation

Question 2

What is the most common cause of secondary hypertension?

Answer 2

Renal disease

If BP is very high or does not respond consider renal artery stenosis

Diagnosed with duplex ultrasound

Question 3

What is an important endocrine cause of hypertension?

Answer 3

Conn’s syndrome

(Hyperaldosteronism)

Question 4

What does high blood pressure increase the risk of developing?

Answer 4

Ischaemic heart disease
Stroke or intracranial haemorrhage
Vascular disease
Hypertensive retinopathy
Hypertensive nephropathy
Left ventricular hypertrophy
HF

Question 5

Why do patients with hypertension develop left ventricular hypertrophy?

Answer 5

Left ventricle strains to pump blood against increased resistance

Muscle hypertrophies

Question 6

How often do NICE recommend measuring blood pressure?

Answer 6

Every 5 years

Every year in patients with DMT2

Question 7

What is white coat syndrome?

Answer 7

More than 20/10mmHg difference in BP between clinic and ambulatory or home readings

Question 8

Complete the table

Answer 8

Question 9

What does NICE recommend all patients with a new diagnosis of hypertension should have?

Answer 9

ACR
Proteinuria
Dipstick for microscopic haematuria

Bloods
HbA1c
Renal function
Lipidprofile

Fundus examination
Hypertensive retinopathy

ECG
Abnormalities
LV hypertrophy

Question 10

If QRISK is above 10% what should be offered?

Answer 10

Atorvastatin 20mg at night

Question 11

What is the pathway of blood pressure management?

Answer 11

ACEinhibitor
Afro Carribean Exempt , give CCB instead

Step 4 depends on serum potassium

Less than or equal to 4.5mmol/L potassium-sparing diuretic (spironolactone)

More than 4.5mmol/L alpha (doxazosin) or beta blocker

Question 12

Why do you have to be careful with giving potassium sparing diuretics and ACEis?

Answer 12

Increases risk of hyperkalaemia

Question 13

What are the target blood pressures?

Answer 13

Under 80
< 140/ < 90

Over 80

< 150 / < 90

Question 14

What is malignant hypertension?

Answer 14

Extremely high blood pressure above 180/120 with retinal haemorrhages or papilloedema

Question 15

What examination do patients with malignant hypertension require?

Answer 15

Fundoscopy examination

Question 16

In a hypertensive emergency what medications can be given IV to reduce BP?

Answer 16

Sodium nitroprusside
Labetalol
Glyceryl trinitrate
Nicardipine

Question 17

Why do you have to be careful reducing blood pressure too quickly in elderly patients?

Answer 17

Higher pressure may be required to force blood through narrowed vessels