treatment of hypertension

Question 1

how would you diagnose hypertension?

Answer 1

Must use ABPM Ambulatory Blood pressure Monitoring

or HBPM Home Blood pressure Monitoring

Question 2

what would be stage 1 hypertension?

Answer 2

Clinic blood pressure is 140/90 mmHg or higher

ABPM daytime average 135/85 mmHg or higher

Question 3

what would be stage 2 hypertension?

Answer 3

Clinic blood pressure is 160/100 mmHg or higher

ABPM daytime average 150/95 mmHg or higher.

Question 4

what would be severe hypertension?

Answer 4

Clinic systolic blood pressure is 180 mmHg or higher or diastolic blood pressure is 110 mmHg or higher.

Question 5

what are the 3 type of treatment for hypertension?

Answer 5

ACE (young)
CCB
thiazide- type diuretic

Question 6

what is the prevelance of pre-hypertension

Answer 6

3-10%

Question 7

what is the prevelance of hypertension depending on age and ethnicity?

Answer 7

0.1-3%

Question 8

what can childhood hypertension lead to?

Answer 8

Adult hypertension

Target organ damage

Question 9

what is the effect of childhood hypertension on end organ damage?

Answer 9

Left ventricular hypertrophy (LVH)
Decreased vascular responsiveness
Increased carotid artery intimal medial thickness (cIMT)
Reduced GFR
Increased atheroma deposition
Reduced cognitive scores in hypertensive children

Question 10

whats the commonest cause of hypertension in newborn infants?

Answer 10

Renal artery thrombosis
Renal artery stenosis
Congenital renal malformations
Coarctation

Question 11

whats the commonest cause of hypertension in infants?

Answer 11

Renal parenchymal disease
Coarctation
Renal artery stenosis

Question 12

whats the commonest cause of hypertension in 6-10 years?

Answer 12

Renal parenchymal disease
Renal artery stenosis
Primary hypertension

Question 13

whats the commonest cause of hypertension in 10-18?

Answer 13

Primary hypertension

Renal parenchymal disease

Question 14

what is accelerated hypertension?

Answer 14

Increase in blood pressure to levels ≥180 mm Hg systolic and ≥110 mm Hg diastolic resulting in target organ damage such as neurological, cardiovascular or renal damage plus grade III retinal changes.

Question 15

what is malignant hypertensiojn?

Answer 15

The term malignant hypertension is usually reserved for cases where papilloedema grade IV fundal changes are present.

Question 16

what is accelerated hypertension associated with?

Answer 16

An existing diagnosis of HTN and prescribed antihypertensive agents.
Poor BP control prior to presentation.
A lack of a primary care contact. Lack of healthcare in general
Non Adherence To Medication.
Illicit drug use in both urban and rural communities.

Question 17

what are the treatment guidelines?

Answer 17

reducing mean arterial pressure by ≤25% for the first hour, and then to 160/100-110 mmHg by 2-6 hours with subsequent gradual normalization over 24-48 hours.

Question 18

what should you not do when treating hypertension?

Answer 18

Do not reduce BP suddenly and excessively.
Do not use sublingual medication.
Do not use rapidly acting nifedipine or ACEI.
Do not use intermittent as required therapy, oral or IV.
Do not use IV hydralazine
5-20 minute lag before producing an erratic response
Do not use sodium nitroprusside