Hypertension

Question 1

What is the normal BP?

Answer 1

<120/80

Question 2

what is the high normal BP?

Answer 2

<140/90

Question 3

What is Grade 1 (mild) HTN?

Answer 3

140-159/90-99

Question 4

What is Grade 2 (moderate) HTN?

Answer 4

160-179/100-109

Question 5

What is Grade 3 (severe) HTN?

Answer 5

>/= 180/110

Question 6

What is isolated systolic HTN?

Answer 6

>/=140/<90

Question 7

What BP should you aim for in someone with >1g/day of proteinuria?

Answer 7

<125/75

Question 8

What BP should you aim for in someone how has had a previous CV event?

Question 9

What BP should you aim for in someone with renal disease?

Answer 9

<130/80

Question 10

What BP should you aim for in someone wih diabetes?

Answer 10

<130/90

Question 11

What BP should you aim for in a healthy person (irrespective of age)?

Answer 11

<140/90

Question 12

What are the causes of HTN?

Answer 12

1. essential HTN (95%)
   
   • multifactorial - genetics and environment
2. secondary HTN
   
   • renal
     
     • DM nephropathy
     • chronic GN
     • PCKD
     • chronic tubulointerstitial nephritis
     • renovascular disease
   • endocrine
     
     • cushings
     • adrenal hyperplasia
     • conn’s disease
     • phaecromocytoma
     • acromegaly
   • CV aortic coarctation
   • medications
     
     • NSADIS
     • OCP
     • steroids
   • pre-eclampsia
   • OSA

Question 13

What investigations should be done when you first establish that a patient has HTN?

Answer 13

• urine dipstick - protein, glucose, blood
• haematocrit
• U&E
• fasting glucose
• cholesterol/HDL/LDL/Triglyceride
• ECG

consider:

• TSH
• serum calcium, phosphate
• CXR, echo

Question 14

What investigations would you do to assess for end-organ damage?

Answer 14

• ECG
• TE
• renal function tests

Question 15

How do you manage someone with HTN?

Answer 15

1. lifestyle modification;
2. pharmacological

Question 16

What modifications to lifestyle would you prescribe to someone with HTN?

Answer 16

SNAP

Smoking cessation

Nutrition - dietary salt restriction, weight loss (waist <94cm men, <80cm women)

Alcohol moderation - <2 stds/day for men, <1 stds/day for women

Physical activity, at least 30 min on most days of week

Question 17

What manageent would you recommend for someone with a low cardiovascular riskprofile?

Answer 17

solely lifestyle modification

Question 18

What antihypertensive treatment would you recommend in someone with HTN and diabetes/lipid abnormalities?

Answer 18

ACE/ARB + Calcium channel blocker

Question 19

What antihypertensive therapy would you recommend for someone with HTN and a PmHx of HF/stroke?

Answer 19

ACEI/ARB + thiazide diuretic

Question 20

What antihypertensive medication would you recommen for someone with HTN and a PmHx of AMI/HF?

Answer 20

ACEI/ARB + beta-blocker

Question 21

What antihhypertensive combinations must you avoid and why?

Answer 21

ACEI/ARB + potassium-sparing diuretic - due to risk of hyperkalaemia

verapamil + beta-blocker - due to risk of heart block

ACEI + ARB - due to risk of syncope and renal dysfunction

Question 22

What are the complications of HTN?

Answer 22

end-organ damage

• hypertensive retinopathy
• hypertensive nephropathy, renal failure
• bioccipital HA
• LVH, HF
• stroke

Question 23

What are the signs of hypertensive retinopathy?

Answer 23

• cotton wool spots
• flame haemorrhages
• exudates
• papilloedema
• microaneurysms

Question 24

What is the definition of malignat HTN?

Answer 24

severe uncontrolled HTN >/= 220/120mmHg