Hypertension

Question 1

What tests need to be carried out in those with a systolic BP reading of >200mmHg

Answer 1

Optic fungi, ECG, and renal function tests

Question 2

What symptoms may be present in those with a systolic >200mmHg?

Answer 2

Visual disturbances, headache, symptoms of organ damage

Question 3

Treatment if clinic BP <140/90 or ABPM/HBPM <135/85mmHg?

Answer 3

Monitoring every 5 years or more often if closer to 140/90mmHg

Question 4

What clinic BP classes as stage 1 hypertension?

Answer 4

> 140/90mmHg

Question 5

What ABPM/HBPM reading classes as stage 1 hypertension?

Answer 5

> 135/85mmHg

Question 6

What clinic BP classes as stage 2 hypertension?

Answer 6

> 160/100mmHg

Question 7

What ABPM/HBPM reading classes as stage 2 hypertension?

Answer 7

> 150/95mmHg

Question 8

What reading classes as severe hypertension?

Answer 8

> 180/110mmHg

Question 9

BP reading required for a pre-eclampsia diagnosis

Answer 9

> !40/90mmHg sustained

Question 10

BP red flag referral symptoms?

Answer 10

Pappiledema, pheochromocytoma, retinal haemorrhage

Question 11

Hypertension stage 1 treatment options

Answer 11

Lifestyle advice + CONSIDER treatment unless < 80 years old with target organ damage, QRISK >10%, CVD, renal disease, or diabetes- DISCUSS treatment

Question 12

When would you consider starting drug treatment in hypertension without a ABPM/HBPM?

Answer 12

If patient has severe hypertension with organ damage

Question 13

When should clinic BP be repeated if patient is found to have severe hypertension and no organ damage?

Answer 13

Within 7 days or HBPM/ABPM recommended

Question 14

Stage 2 hypertension treatment options

Answer 14

DISCUSS treatment options

Question 15

BP target for those <80 years old

Answer 15

Clinic <140/90
ABPM/HBPM <135/88

Question 16

BP targets for those >80 years old

Answer 16

Clinic <150/90
ABPM/HBPM <145/85

Question 17

Which patient groups should standing and sitting BP be measured in?

Answer 17

> 80 years old
T2DM
Those with history of postural hypotension

Question 18

Treatment option for those with black-african/ carribean origin despite age?

Answer 18

CCB

Question 19

Treatment option for white ethnicity, >55, without diabetes

Answer 19

CCB

Question 20

Treatment option for white ethnicity, <55, without diabetes

Answer 20

ACE-I/ARB

Question 21

Treatment option for white ethnicity, >55, with diabetes

Answer 21

ACE-I/ARB

Question 22

When should an ARB be considered over an ACE-I?

Answer 22

In those of Black- African or Carribean orgin

Question 23

When should a thiazide-like diuretic be considered in hypertension?

Answer 23

Step 1 treatment if signs of HF

Question 24

Step 2 hypertension treatment

Answer 24

Dual therapy with CCB and ACE-I/ ARB

Question 25

Step 3 hypertension therapy

Answer 25

Triple therapy with CCB and ACE-I/ARB and thiazide-like diuretic

Question 26

Step 4 (resistant hypertension) treatment

Answer 26

low dose-spironolatone or alpha/beta-blocker

Question 27

Potassium level required to introduce spironolactone

Answer 27

<4.5mmol/L

Question 28

Potassium level required to introduce alpha-blocker

Answer 28

>4.5mmol/l

Question 29

Which antihypertensives are CI in pregnancy and breastfeeding?

Answer 29

ACE-I/ARBs

Question 30

SEs of ACE-I

Answer 30

Dry cough, renal impairment, hyperkalaemia, angio-oedema, dizziness, hepato-biliary disorders (ARBs the same minus dry cough)

Question 31

SEs of CCBs

Answer 31

angio-oedema, flushing, peripheral oedema, palpitations, headache, dizziness, GI disturbances.

Question 32

CI of CCBs

Answer 32

Reduced LVEF/ uncontrolled HF, MI within 1 month

Question 33

Cautions of ACE-I/ARBs

Answer 33

stenosis, cardiomyopathy, history of angio-oedema

Question 34

When shpuld renal function be monitored on ACE-I/ARBs

Answer 34

1-2 weeks after initiation and after dose changes, then annually

Question 35

BP target for patients with CKD

Answer 35

<140/90mmHg

Question 36

BP target for patients with CKD + diabetes, or ACR of >70mg/mmol

Answer 36

<130/80mmHg

Question 37

1st line for hypertension in pregnancy

Answer 37

Labetalol

Question 38

2nd line for hypertension in pregnancy

Answer 38

MR Nifedipine

Question 39

3rd line for hypertension in pregnancy

Answer 39

Methyldopa (unlicensed)

Question 40

Antihypertensive used in emergency situations/ severe hypertension in pregnnacy?

Answer 40

IV Magenisum Sulphate

Question 41

Reversal agent for CCB in overdose, to be given within 1 hour?

Answer 41

Activated charcoal

Question 42

Reversal agent for CCB in significant overdose?

Answer 42

Calcium gluconate or chloride IV

Question 43

What is used to treat bradycardia associated with CCB overdose?

Answer 43

Atropine sulphate