Essential or secondary hypertension

Question 1

What is the NICE definition of hypertension

Answer 1

clinic reading persistently above >=140/90
OR
24 hour blood pressure average reading >= 135/85

Question 2

What is essential/primary hypertension

Answer 2

no single disease causing rise in BP instead just as series of complex physiological changes which occur as we get older

Question 3

What are some renal causes of secondary hypertension

Answer 3

glomerulonephritis
chronic pyelonephritis
adult polycystic kidney disease
renal artery stenosis

Question 4

What are some endocrine causes of secondary hypertension

Answer 4

primary hyperaldosteronism - Conns syndrome

Pheochromocytoma

Cushing’s syndrome

Liddle’s syndrome

CAH - 11 beta hydroxylase deficiency

Acromegaly

Question 5

What are some other causes of secondary hypertension

Answer 5

glucocorticoids
NSAIDs
pregnancy
coarctation of the aorta
Combined oral contraceptive pill

Question 6

What symptoms does hypertension present with

Answer 6

does not typically cause symptoms unless very high – 200/120
patients may experience
- headaches
-visual disturbances
-seizures

Question 7

What is important to do when assessing a newly diagnosed patient with hypertension

Answer 7

ensure they do not have any end-organ damage

fundoscopy- check for hypertensive retinopathy

urine dipstick - check for renal disease

ECG - check for LVH or ischaemic heart disease

Question 8

What investigations are needed

Answer 8

24 hour blood pressure monitoring

Question 9

What tests are usually required after diagnosis

Answer 9

U&Es - check for renal disease
HbA1c- check for co-existing DM
lipids- check for hyperlipidaemia
ECG
urine dipstick

Question 10

What is management for someone with hypertension and type 2 diabetes

Answer 10

1st line - ACEI or ARB
2nd line - add CCB or thiazide like diuretic

Then ACEI/ARB +CCB+thiazide like diuretic

Question 11

What is management for someone <55 and not of black african/african caribbean descent ( non-diabetic )

Answer 11

1st line - ACEI/ARB
2nd line - add CCB or thiazide like diuretic

Then ACEI/ARB and CCB and thiazide like diuretic

Question 12

What is the management for someone with hypertension that is >55 or black african/afro-carribean ( no diabetes)

Answer 12

first line is CCB
second line- CCB and ACE/ARB or thiazide liek diuretic

ACEI/ARB and CCB and thiazide like diuretic

Question 13

What are common side effects of ACEI

Answer 13

cough
angioedema
hyperkalaemia

-PRIL

Question 14

What are common side effects of CCB

Answer 14

flushing
ankle swelling
headache

• AMLODIPINE

Question 15

What are common side effects of thiazide type diuretics

Answer 15

hyponatraemia
hypokalaemia
dehydration

• Indapamide

Question 16

What are common side effects of ARBs

Answer 16

hyperkalaemia
-SARTAN

Question 17

What are the grades of hypertensive retinopathy

Answer 17

Grade 0 - no changes

Grade 1- slight arterial narrowing

Grade 2 - obvious arterial narrowing with focal irregularities

Grade 3- Grade 2 plus retinal haemorrhages, exudates, cotton wool spots or retinal oedema

Grade 4- Grade 3 plus papilledema