Hypertension

Question 1

What blood pressure is classed as hypertensive in clinic?

Answer 1

140/90 or greater

Question 2

What blood pressure is classed as hypertension at home / not measured by doctor/ using ABPM?

Answer 2

135/85 or greater

Question 3

What is the most common cause of secondary hypertension?

Answer 3

CKD as result of diabetic nephropathy

Question 4

What are other common causes of secondary hypertension?

Answer 4

Endocrine conditions like Pheochromocytoma
Conn’s disease
Cushing’s disease

Pregnancy

Question 5

What are risk factors for hypertension?

Answer 5

Age
Black ethnicity
Overweight
Lack of exercise
Smoking
Diabetes
Stress
Increased salt intake
Family history

Question 6

What is stage 1 hypertension?

Answer 6

Over 140/90 mmHg in clinic
or
over 135/85 mmHg at home

Question 7

What is stage 2 hypertension?

Answer 7

Over 160/100 mmHg in clinic
or
over 150/95 mmHg at home

Question 8

What is stage 3 hypertension?

Answer 8

Over 180/110 mmHg

Question 9

What causes hypertension?

Answer 9

Increased RAAS and SNS activity increase CO and TPR (Total Peripheral Resistance)

Increased CO and TPR = Increased bp

BP = CO x TPR

Question 10

True or false: hypertension is most often asymptomatic, may have pulsatile headache

Answer 10

True

Question 11

True or false: malignant hypertension is caused by cancerous malignancies creating an inflammatory reaction

Answer 11

False
Nothing to do with cancer, just causes very acute severe symptoms

Question 12

What are symptoms of malignant hypertension (acute and severe)?

Answer 12

Heart failure (LVH)
Blurred vision (papilledema, retinal haemorrhage)
Haematuria and renal failure (glomerulonephritis)
Headache, risk of cerebral haemorrhage

Question 13

How is hypertension diagnosed?

Answer 13

BP reading in hospital being 140/90+ mmHg
then ABPM to for 24 hours to confirm diagnosis (bp of 135/85 throughout day)

Assess end organ damage

Question 14

How is end organ damage assessed?

Answer 14

Fundoscopy for papilledema

Urinalysis, eGFR, serum creatinine and glucose for renal function and diabetes risk

ECHO/ECG for LVH

Question 15

What is the first step in treatment for hypertension if younger than 55 or has T2 diabetes?

Answer 15

ACE-inhibitor

(contraindicated if on ARB)

Question 16

What is the first step in treatment of hypertension in patients over 55 or black African patients?

Answer 16

CCB

Question 17

What group of patients would be prescribed ACE-i initially to treat hypertension?

Answer 17

Those under 55
Those with T2DM

Question 18

What group of patients would be prescribed CCB initially to treat hypertension?

Answer 18

Those aged 55+
Black Africans

Question 19

What would be the initial treatment for hypertension in a 66 y/o Black African man with T2 diabetes?

Answer 19

ACE-i
(T2DM trumps age or being Black African)

Question 20

What is the 2nd stage in treatment for hypertension?

Answer 20

ACE-i and CCB

Question 21

What is the 3rd stage in treatment for hypertension?

Answer 21

ACE-i and CCB and thiazide like diuretic or thiazide (less potent)

Thiazide-like diuretic = Indapamide

Thiazide: Bendroflumethiazide

Question 22

What is the 4th stage in treatment for hypertension?

Answer 22

ACE-i + CCB + TLD + 4th drug depending on potassium levels

If K+ more than 4.5 then alpha or beta blocker

If K+ less than 4.5 then spironolactone (K+ sparing)

Question 23

Name all drugs given by the 4th stage of treatment for hypertension for a patient with K+ of 3.0

Answer 23

Ramipril (ACEi)
Amlodipine (CCB)
Indapamide (Thiazide-like diuretic)
Spironolactone

Question 24

Name all drugs given by the 4th stage of treatment for hypertension for a patient with K+ of 5.0

Answer 24

Ramipril (ACE-i)
Amlodipine (CCB)
Indapamide (TLD)
Atenolol (B-blocker)

Question 25

What are complications of hypertension?

Answer 25

Heart failure
Increased IHD risk
CKD
Increased risk of cerebrovascular accident