Hypertension

Question 1

outline the classification of severity of HTN

Answer 1

HTN= >140/90

• stage 1= >140/90
• stage 2= >160/100
• stage 3= >180/110

Malignant= >180/110 PLUS papilloedema and/or retinal haemorrhage

Question 2

causes of secondary HT? mnemonic

Answer 2

ROPE

• Renal
  
  • chronic renal failure
  • renal artery stenosis
  • PKD
• Obesity
• Pregnancy induced /PET
• Endocrine
  
  • hyperaldosteronism
  • cushing’s
  • DM
  • Phaeochromocytoma
  • acromegaly
  • congenital adrenal hyperplasia
  • hyperthyroidism
• co-arctation of aorta

Question 3

symptoms?

Answer 3

• headache
• dizziness
• burred vision
• epistaxis
• angina
• syncope

Question 4

Ix?

Answer 4

• several BP readings in clinic / 24h ambulatory BP
• bloods
  
  • FBC, UE, eGFR, glucose & lipid profile
• urine
  
  • dipstick, Albumin:Cr ratio
• ECG
• calculate 10yr CV risk

Question 5

Mx?

Answer 5

1.Lifestyle interventions

• reduce risk factors ie smoking /salt intake
• increase exercise & healthy diet

2. Medical Mx

Question 6

what is indicated for 1st line prevention if 10yr CV risk >20%

Answer 6

statins

Question 7

Medications used?

Answer 7

Medications:

ACEI (ramipril)

Beta blocker (bisoprolol)

CCB (amlodipine)

Diuretic (thiazide-like)- indapamide

ARB- candesartan

Question 8

when are ARB’s given?

Answer 8

if intolerant to ACEI / afro-caribbean

Question 9

Medical Mx stepwise approach

Answer 9

1. <55 / T2DM= A. >55+ non-diabetic or black use C
2. non-black use A+C (black use ARB instead of A)
3. A+C+D
4. A+C+D+ depends on K

Question 10

Which diuretic is added in step 4?

Answer 10

• if serum K <4.5 –> K sparing diuretic ie spironolactone
• if serum K >4.5 –> alpha/beta blocker

Question 11

Rx targets?

Answer 11

< 80: <140/90

>80: <150/90

Question 12

complications?

Answer 12

• IHD/ HF / AA
• CVA
• Hypertensive retinopathy
• Hypertensive neuropathy

Question 13

what is malignant HTN?

Answer 13

• medical emergency
• fibrinoid necrosis of small arteries / arterioles & dilation of cerebral arteries

Question 14

symptoms of malignant HTN

Answer 14

• headache
• vomiting
• visual disturbance
• papilloedema
• convulsions

Question 15

Rx of malignant HTN

Answer 15

IV Labetolol

be careful to bring BP down slowly, over 4hrs