Hypertension

Question 1

hypertension blood pressure
how common
risk factor for…

Answer 1

> =140/90mmHg
50% of >60 years
stroke, myocardial infarction, heart failure
‘silent killer’

Question 2

causes of primary hypertension(90-95%)

Answer 2

family history
obesity
excess salt in diet
excess alcohol intake

Question 3

causes of secondary hypertension(5-10%)

Answer 3

reno(vascualr)
endocrine
coarctation of aorta
pregnancy induced
exogenous hormones

Question 4

possible consequences of not diagnosing and treating hypertension

Answer 4

can lead to heart attack, stoke or end-stage renal failure

Question 5

how to measure blood pressure

Answer 5

sphygmomanometer- rubber cuff on arm connected to column of mercury attached to graduating scale. determines BP by increasing and releasing pressure in cuff

Question 6

types of manual BP devices

Answer 6

aneuroid sphygmomanometer
mercury sphygmomanometer

Question 7

types of automated BP devices

Answer 7

digital monitor- general use
ambulatory monitor- portable
‘waiting room’ BP monitor- GP surgery

Question 8

steps for taking BP

Answer 8

choose correct cuff size
patients sit and rest for 5 mins
place their arm at heart level
make sure they dont talk or move while taking BP

Question 9

How to use manual monitors

Answer 9

palpate brachial artery
inflate cuff until palpations disappears
deflate cuff
inflate to 30 more than pressure when palpation disappeared
place stethoscope on brachial artery and deflate slowly until hear tapping sound
measure systolic and diastolic

Question 10

Diagnosis and investigation of hypertension

Answer 10

> 140/90mmHg clinical BP
135/85 ABPM BP
if this is case record again, if vastly different take a third and only record lower of last 2 readings
also offer ambulatory blood pressure monitoring
if cant handle ABPM offer home blood pressure monitoring

Question 11

severe hypertension

Answer 11

BP(systolic)>=180 or BP(diastolic)>=120
start antihypertensiondrug treatment ASAP
as if left untrated can lead to end organ damage

Question 12

factors that suggest hypertension

Answer 12

clinical BP 140/90mmHg or higher with HBPM 135/85 or higher
stage 1- clinical BP>=140/90 and BP<=159/99
stage 2 BP>=160/100

Question 13

investigations

Answer 13

-target organ damage: urinanalysis, ECG, fundoscopy
-secondary causes: MR renal angiogram, plasma renin, aldesterone levels, endocardiogram

Question 14

treatment

Answer 14

lifestyle intervention- weight loss (diet and exercise)
target BMI 20-25
reduce alcohol intake
reduce caffine intake
reduce salt intake
treat secondary causes- adrenal tumor surgery
antihpertension drug therapy- depends on age, ethnicity, reactivity
Ace inhibitors
Beta blockers
Calcium channel blockers
Diuretics

Question 15

what drug to choose

Answer 15

depends on age, ethnicity, previous adverse reaction
A(B)CD method to decide
ACE inhibitors/ angiotensin receptor blocker
beta blockers
calcium channel blocker
diuretics

Question 16

steps to decide drug

Answer 16

if younger than 55 give (A) unless patient is black
then decide to give with C,D or both
if patient is older than 55 or black give C,D or both