Hypertension

Question 1

What is the difference between primary and secondary hypertension ?

Answer 1

Primary/“Essential” Hypertension
-No clear single etiology
-Due to complex interaction between a genetic background and environmental factors
-Most common form of hypertension in adults

Secondary Hypertension
-Specific underlying cause
-5-10% of all hypertension cases in adults
-70-85% of hypertension cases in children under 12 years old

Aetiology = cause

Question 2

What are common and uncommon causes of secondary hypertension ?

Answer 2

Common
-Obstructive Sleep Apnoea
-Renal disease
-Aldosteronism; too much aldosterone e.g. due to adrenal adenoma (Conn’s disease)
-Reno-vascular disease

Uncommon
-Cushings
-Hyperparathyroidism
-Aortic coarctation

Question 3

How is hypertension diagnosed ?

Answer 3

ABPM or Home BP

Question 4

What does APBM record ?

Answer 4

Ambulatory Blood Pressure Monitoring
-at least two measurements per hour during the person’s usual waking hours (usually 14/day).

Question 5

What does HBPM record ?

Answer 5

Two consecutive seated measurements, 1 minute apart
-BP is recorded twice a day for at least 4 days and preferably for 7 days
-measurements on the first day are discarded – average value of all remaining is used.

Question 6

How is blood pressure taken in a clincic ?

Answer 6

Check the pulse before measuring BP, if irregular measure BP manually. Regular pulse means can use automated

Question 7

What is the “White Coat” effect ?

Answer 7

Nervous patient has higher BP in clinic; discrepancy of more than 20/10mmHg between clinic and average daytime ABPM or average HBPM blood pressure measurements at the time of diagnosis
-Typically; older, female, smoker with high clinic SBP and variable daytime readings
-Use ABPM or HBPM

Question 8

What is masked hypertension ?

Answer 8

Relaxed patient in clinic has normal BP but really has hypertension
-20% of people with hypertension have this
-Ambulatory BP Is done

Question 9

What are the stages of hypertension ?

Answer 9

Stage 1 hypertension:
-Office BP is 140/90mmHg or higher and
-ABPM or HBPM daytime average is 135/85mmHg or higher

Stage 2 hypertension:
-Office BP 160/100mmHg or higher and
-ABPM or HBPM daytime average is 150/95mmHg or higher

Severe hypertension:
-Office SBP is 180mmHg or higher or
-Office DBP is 110mmHg or higher.

Question 10

What is the definition of hypertension ?

Answer 10

Hypertension is defined based on repeated office Systolic Blood Pressure (SBP) >140 mmHg and/or Diastolic Blood Pressure (DBP) >90 mmHg.

Question 11

How is cardiovascular risk and target organ damage assessed in a patient with hypertension ?

Answer 11

For all with hypertension offer to:
-Test urine for presence of protein
-Blood to measure glucose, cholesterol, electrolytes, creatinine, estimated glomerular filtration rate
-12-lead ECG (?LVH)
-Examine fundi for hypertensive retinopathy

Hypertension can cause organ damage

Question 12

What is HMOD ?

Answer 12

Hypertension Mediated Organ Damage (HMOD)
-Left Ventricular Hypertrophy
-Creatinine Raised
-Albuminuria / microalbuminuria
-Retinopathy

Question 13

What should not remain first choice in the treatment of primary hypertension ?

Answer 13

Beta-blockers