Hypertension

Question 1

What is the ideal environment for measuring BP and what is tricky about it?

Answer 1

Want a relaxed, temperate setting with the person seated.
People can often get the ‘white coat effect’ where their BP is mcuh higher in the clinical setting than at home. Slide 12+18

Question 2

What is the clinical BP for hypertension and what else should you do to ensure the patient is hypertensive?

Answer 2

140/90 mmHg and above

Offer an ambulatory blood pressure moniter (ABPM). Slide 13

Question 3

What is part of the new NICE guidlines for diagnosing hypertension?

Answer 3

Hypertension must be diagnosed using ABPM. Slide 14

Question 4

How should the ABPM be used?

Answer 4

At least 2 measurements per hour during the persons usual waking hours. Slide 16

Question 5

What are the 3 stages of hypertension?

Answer 5

Stage 1: clinical BP of 14/90 or higher AND ABPM daytime average of 135/85 or higher.

Stage 2: Clinical BP 160/100 or higher AND ABPM daytime average of 150/95 or higher

Severe hypertension 180 mmHg or higher OR clinical diastolic is 110 or higher. Slide 17

Question 6

What are the 4 categories of BP when measuring it?

Answer 6

True normotension
White coat hypertension (clinical setting)
Sustained hypertension 
Masked hypertension 
Slide 20

Question 7

If a patient has hypertension what should be offered to them incase of CVD risk?

Answer 7

Urine test - protein presence
Blood test - creatinine levels
Examine fundi
12 lead ECG. Slide 22

Question 8

What is the main risk factor for absolute risk of hypertension?

Answer 8

Age. Slide 23

Question 9

What are the Keith-Wagner-Barker classifications of hypertensive retinopathy?

Answer 9

Grade I: Narrowing of arterioles
Grade II: More narrowing, AV nicking
Grade III: The above and soft exudate and haemorrhages
Grade IV: all the above and papilloedema. Slide 34

Question 10

What are the targets for BP for people under 80 and over 80?

Answer 10

<80 - 140/90 mmHg

>80 - 150/90 mmHg. Slide 41

Question 11

Does decreasing the diastolic BP by 5 mmHg have a large impact on CVD risk?

Answer 11

Yes, reduces stroke risk by 40% and CVD by 25%. Slide 51

Question 12

What are common causes for secondary hypertension?

Answer 12

Renal disease
Obstructive sleep apnoea
Aldosteronism
Reno-vascular Disease. 
Slide 52

Question 13

What are uncommon causes for secondary hypertension?

Answer 13

Cushing's
Pheochromocytoma
Hyperparathyroidism
Aortic coarction
Intracranial tumour. Slide 52

Question 14

Who usually present with fibromuscular dysplasia and why is it beneficial if spotted?

Answer 14

Curable form of hypertension

Usually found in young woman with low potassium and high BP. Slide 64