Hypertension

Question 1

What are investigations for Hypertension?

Answer 1

Use of ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM)

Fasting glucose

Cholesterol

Urinalysis

Special Tests

Question 2

What are the stages of Hypertension?

Answer 2

Stage 1
Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

Stage 2
Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg

Severe hypertension
Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 110 mmHg

Question 3

How is hypertension diagnosed?

Answer 3

• Measurement of blood pressure in both arms. Difference in readings between arms is consistently > 20 mmHg then subsequent blood pressures should be recorded from the arm with the higher reading
• Suggest offering ABPM or HBPM to any patient with a blood pressure >= 140/90 mmHg

Question 4

What is the management if there is a blood pressure of >= 180/110 mmHg?

Answer 4

• Immediate treatment should be considered
• If there are signs of papilloedema or retinal haemorrhages NICE recommend same day assessment by a specialist
• NICE also recommend referral if a phaeochromocytoma is suspected (labile or postural hypotension, headache, palpitations, pallor and diaphoresis)

Question 5

What is the ambulatory blood pressure monitoring?

Answer 5

• At least 2 measurements per hour during the person’s usual waking hours (for example, between 08:00 and 22:00)
• Use the average value of at least 14 measurements

Question 6

What is offered if ABPM is not tolerated?

Answer 6

Home blood pressure monitoring (HBPM)

• for each BP recording, two consecutive measurements need to be taken, at least 1 minute apart and with the person seated
• BP should be recorded twice daily, ideally in the morning and evening
• BP should be recorded for at least 4 days, ideally for 7 days
• Discard the measurements taken on the first day and use the average value of all the remaining measurements

Question 7

How are the results interpreted for ABPM/HPBM?

Answer 7

ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension)

ABPM/HBPM >= 150/95 mmHg (i.e. stage 2 hypertension) offer drug treatment regardless of age

Question 8

When do you treat ABPM/HBPM >= 135/85 mmHg?

Answer 8

Treat if < 80 years of age AND any of the following apply

• target organ damage, established cardiovascular disease
• renal disease
• diabetes
• 10-year cardiovascular risk equivalent to 20% or greater

Question 9

What are special tests done in Hypertension?

Answer 9

• Renal Ultrasound/Arteriography: renal artery stenosis
• 24h metanephrines: Pheochromacytoma
• Urinary free Cortisol: Cushing’s Syndrome
• Aldosterone and Renin: Conn’s Syndrome