Hypertension

Question 1

What is the BP needed to diagnose HTN?

Answer 1

above 140/90 in the clinical setting, confirmed with ambulatory or home readings above 135/85.

Question 2

What are the secondary causes of HTN? (5)

Answer 2

• R – Renal disease
• O – Obesity
• P – Pregnancy-induced hypertension or pre-eclampsia
• E – Endocrine
• D – Drugs (e.g., alcohol, steroids, NSAIDs, oestrogen and liquorice)

Question 3

What is the main endocrine cause of HTN?

Answer 3

Conns syndrome

Question 4

What is the main renal cause of HTN?

Answer 4

Renal artery stenosis

Question 5

What are some complications of HTN? (8)

Answer 5

• Ischaemic heart disease (angina and acute coronary syndrome)
• Cerebrovascular accident (stroke or intracranial haemorrhage)
• Vascular disease (peripheral arterial disease, aortic dissection and aortic aneurysms)
• Hypertensive retinopathy
• Hypertensive nephropathy
• Vascular dementia
• Left ventricular hypertrophy
• Heart failure

Question 6

How often should BP be measured?

Answer 6

Even 5 years
More often if borderline
Every year in patients with T2DM

Question 7

When should patients have home readings / ambulatory BP taken?

Answer 7

If BP is found to be between 140/90 and 180/120

Question 8

What is stage 1 HTN?

Answer 8

Clinic reading = over 140/90
Home reading = over 135/85

Question 9

What is stage 2 HTN?

Answer 9

Clinic reading = over 160/100
Home reading = over 150/95

Question 10

What is stage 3 HTN?

Answer 10

Clinic reading over 180/120

Question 11

What investigations should be done in HTN to test for end organ damage?

Answer 11

• Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuriato assess for kidney damage
• Bloods for HbA1c, renal function and lipids
• Fundus examination for hypertensive retinopathy
• ECG for cardiac abnormalities, including left ventricular hypertrophy

Question 12

What is the first line management of HTN for someone under 55 or a type 2 diabetic?
Second line?
Third line?
Fourth line?

Answer 12

1. ACEi
2. ACEi and CCB
3. ACEi and CCB and thiazide like diuretic
4. As above plus 4th agent

Question 13

What is the first line management of HTN for someone over 55 or black African ?
Second line?
Third line?
Fourth line?

Answer 13

1. CCB
2. ACEi and CCB
3. ACEi and CCB and thiazide like diuretic
4. As above plus 4th agent

Question 14

For what groups is CCB first line in HTN?

Answer 14

Over 55
Black African

Question 15

For what patients is ACEi first line for HTN?

Answer 15

Under 55
T2DM

Question 16

When should ARBs be used instead of ACEi in HTN management?

Answer 16

If black African
If not tolerated e.g. dry cough

Question 17

What is the main side effect of CCBs?

Answer 17

Ankle oedema

Question 18

What is the main side effect of ACEi?

Answer 18

Dry cough

Question 19

What are the 2 drugs used for step 4 of HTN management and when are each indicated?

Answer 19

§ Less than or equal to 4.5 mmol/L consider a potassium-sparing diuretic, such as spironolactone

		§ More than 4.5 mmol/L consider an alpha blocker (e.g., doxazosin) or a beta blocker(e.g., atenolol)

Question 20

What is the action of spironolactone?

Answer 20

Blocks action of aldosterone in the kidneys
Leads to sodium excretion and potassium reabsorption
Diuresis and Hyperkalaemia

Question 21

What are HTN targets for under 80yo and over 80yo?

Answer 21

Under 80 = <140/90
Over 80 = <150/90

Question 22

What is accelerated hypertension?

Answer 22

Accelerated hypertension, also called malignant hypertension, refers to extremely high blood pressure, above 180/120, with retinal haemorrhages or papilloedema.

Question 23

What should be done if someone has accelerated HTN?

Answer 23

Same day referral for hospital admission
Require Fundoscopy
Assess secondary cause
Assess end organ damage

Question 24

What IV medications are available in a hypertensive emergency? (4)

Answer 24

• Sodium nitroprusside
• Labetalol
• Glyceryl trinitrate
• Nicardipine