Hypertension

Question 1

If new BP > 180/20 + no worrying signs …

Answer 1

Urgent investigations for end organ damage: ECG, urine dip, blood tests

Question 2

If new BP >180/20 and worrying signs.. (new-onset confusion, chest pain, signs of heart failure, or acute kidney injury)

Answer 2

Urgent same day specialist assessment

Question 3

If clinic reading >140/90…

Answer 3

Offer ABPM or HBPM

Question 4

If ABPM / HBPM > 135/85…

Answer 4

Stage 1 hypertension

Question 5

treat stage 1 hypertension IF … AND …

Answer 5

> 80yo AND
-end organ damage
-renal disease
-diabetes
-10yr QRISK2 >10%

Question 6

If ABPM /HBPM >150/90…

Answer 6

Stage 2 hypertension: treat all patients regardless of age

Question 7

Hypertension treatment step 1

Answer 7

If less than 55 and non black: ACE
If over 55 or black: calcium channel inhibitor

Question 8

Hypertension treatment step 2

Answer 8

If non black use: ACE + Calcium channel inhibitor
If black: Calcium channel inhibitor + ARB

Question 9

Hypertension treatment step 3 and 4

Answer 9

Step 3: A + C + Thiazide like diuretic
Step 4: A + C + D + spironolocation (if Na >4.5) OR Indiapamide (<4.5)

Question 10

Hypertension treatment step 3 and 4

Answer 10

Step 3: A + C + Thiazide like diuretic
Step 4: A + C + D + spironolocation (if Na >4.5) OR Indiapamide (<4.5)

Question 11

What must be checked before initiating ACE inhibitors and after increasing dose

Answer 11

U&E

Question 12

when is indapamide contraindicated in hypertension for 4th line treatment, give instead

Answer 12

in hyponatreamia

Question 13

what hypertension medication can cause gout flare up by increasing serum uric acid

Answer 13

Bendroflumethiazide

Question 14

which hypertension drug can cause increase hba1c in diabetes

Answer 14

Bendroflumethiazide
by decreasing insulin secretion and sensitivity

Question 15

if albumin:creatinine ratio in CKD >30, what hypertension medication should be used in ALL patients?

Answer 15

ACE inhibitor

Question 16

management of patient <40 stage 1 hypertension and no end organ damage

Answer 16

refer to secondary care to exclude secondary causes of hypertension

Question 17

maximum dose of ramipril daily

Answer 17

10mg

Question 18

bp target in CKD with acr >70

Answer 18

<130/80

Question 19

1st line treatment hypertension type 2 diabetes

Answer 19

ACE or ARB

Question 20

target bp clinic vs ABMP
age <80

Answer 20

clinic: 140/90
ABMP: 135/85

Question 21

target bp clinic vs AMBP
>80

Answer 21

clinic: 150/90
ABMP: 145/85

Question 22

what increase in creatinine is acceptable following the introduction of an ACE inhibitor in CKD

Answer 22

30%

Question 23

what increase in GFR is acceptable following the introduction of an ACE inhibitor in CKD

Answer 23

25%

Question 24

referal bp in pregnancy

Answer 24

140/90

Question 25

what happens to bp in pregnancy

Answer 25

falls in first half and returns to normal in second half

Question 26

how to treat postural hypertension

Answer 26

based on standing blood pressure

Question 27

what anti-hypertensive is contraindicated in patients with renovascular disease

Answer 27

Amlodipine

Question 28

target blood pressure type 2 diabetic

Answer 28

<140/90