Hypertension

Question 1

What is stage one hypertension?

Answer 1

Clinic more than or equal to 140/90

ABPM more than or equal to 135/85

Question 2

What is stage two hypertension?

Answer 2

Clinic more than or equal to 160/100

ABPM more than or equal to 150/95

Question 3

What is severe hypertension?

Answer 3

Clinic more than or equal to 180 systolic

ABPM more than or equal to 110 systolic

Question 4

What is the BP target of someone below 80 years?

Answer 4

<140/90

Question 5

What is the BP target of someone above 80 years?

Answer 5

<150/90

Question 6

What us essential hypertension?

Answer 6

High BP where an underlying cause cannot be identified

Question 7

What is secondary hypertension?

Answer 7

High BP where an underlying cause is identified

e.g. renal or endocrine disease, COCs, venlafaxine, sympathomimetics and alcohol

Question 8

What is white coat hypertension?

Answer 8

Clinic BP of 140/90 or higher but normal when assessed by ABPM

Question 9

When should BP be reassessed?

Answer 9

BP< 140/90 reassess every 5 years

Increased frequency if BP close to 140/90 (annually)

Question 10

What is the target BP for the majority of people with diabetes?

Answer 10

<140/80

Question 11

What is the BP target for diabetics at ‘high risk’?

Answer 11

<130/80

Question 12

What drug class is 1st line for people with T2DM and HTN?

Answer 12

ACE inhibitors

Unless African-Carribbean= ACEi plus CCB or diruretic

Question 13

What drug classes can be particularly beneficial for people with renal failure?

Answer 13

ACEis and ARBs

Question 14

what drugs are most commonly sued for HTN in pregnancy?

Answer 14

Labetalol, methyldopa, CCBS (Nifedpine)`

Question 15

What is the advice on weight, dietary sodium intake and exercise for people with HTN?

Answer 15

BMI 20-25 kg/m2
<100mmol/day sodium (<6g salt)
30-60 mins of exercise 3-5 times a week

Question 16

What are two non-dihydropyridine CCBs?

Answer 16

Diltiazem

Verapamil

Question 17

Name 3 longer acting dihydropyridine CCBs?

Answer 17

Amlodipine
Felodipine
MR Nifedipine

Question 18

Why are Diltiazem and Verapamil rarely used in HTN?

Answer 18

Due to their interactions and effect on cardiac rhythm

Question 19

What are the most common adverse effects experienced with CCBS?

Answer 19

Oedema, headache, GI disturbances and flushing

Question 20

What is a common SE of verapamil?

Answer 20

Constipation

Question 21

What renal effect must ACEis have in order for them to be stopped?

Answer 21

Cr rise by more then 20%
or
eGFR falls by more than 15%

Question 22

What are 3 SEs of ACEis?

Answer 22

Worsening renal function
Hyperkalaemia
Dry cough

Question 23

Name 2 thiazide like diuretics

Answer 23

Chlortalidone

Indapamide

Question 24

What are 6 adverse effects of thiazide diuretics?

Answer 24

Impaired glucose intolerance
Hypokalaemia
Hyponatraemia
Increase in plasmid lipids
Gout
Impotence

Question 25

When are B-blockers advised?

Answer 25

In younger people | People with HTN and angina

Question 26

Why are B-blokers contraindicated in asthma?

Answer 26

risk of bonchospasm

Question 27

What problems can Prazosin cause?

Answer 27

Postural hypotension, dizziness, vertigo

Question 28

What are a) short acting b) Long acting a blockers?

Answer 28

a) Prazosin | b) Doxazosin, Terazosin

Question 29

What is spironolactone?

Answer 29

An aldosterone antagonist

Question 30

What is a SE of spironolactone?

Answer 30

Hyperkalaemia

Question 31

What can hydralazine cause when used alone?

Answer 31

Tachycardia | Fluid retension

Question 32

What adverse effects does Minoxidil frequently cause?

Answer 32

Peripheral oedema, reflex tachycardia, hair growth

Question 33

What are 3 centrally acting antihypertensives?

Answer 33

Clonidine Methyldopa Moxonidine

Question 34

When should thiazides be avoided?

Answer 34

eGFR< 30ml/min

Question 35

Each HTN QoF point is worth approx how much?

Answer 35

£160 to the practice

Question 36

What are the monitoring requirements for ACEis/ARBs?

Answer 36

Baseline U+Es BP/U+Es within 10 days and then 3 months of commencing or changing dose then annually. If Cr increased by >20% or eGFR decreased by >15% stop ACEi, monitor and refer. If K is more than or equal to 5.0mmol/L stop ACEi, monitor and refer

Question 37

What are the monitoring requirements for diuretics?

Answer 37

Baseline U+Es/urinalysis U+Es after 1 months or dose changes U+Es annually once stable Urinalysis annually

Question 38

What must happen if ABPM is not available?

Answer 38

Individual must return for at least another 2 subsequent clinic visits (2 week intervals). BP assessed from at least to readings. If over 75- 3rd reading standing to detect postural hypotension

Question 39

What is 'optimal BP'?

Answer 39

<120/<80

Question 40

What is 'normal' BP?

Answer 40

<130/<85

Question 41

What is 'high normal' BP?

Answer 41

130-139/85-89

Question 42

How often should a person with HTN be monitored?

Answer 42

BP/pulse- 6 monthly Urinalysis-annually Fasting lipids- annually FBC- 5 yearly

Question 43

Diastolic or systolic BP is more commonly raised in people younger than 50?

Answer 43

Diastolic

Question 44

When using ABPM to confirm a HTN diagnosis, what needs to be ensured?

Answer 44

at least 2 measurements per hour are taken during the person's usual waking hours

Question 45

For ABPM, the average of how many readings should be used?

Answer 45

At least 14

Question 46

What is the advice for HBPM for HTN diagnosis?

Answer 46

2 consecutive measurements are taken at least 1 min apart with person seated. BP recorded twice daily. Recording continues for at least 4 days, ideally 7. Discard readings taken on day 1

Question 47

A fall in BP by more than what when a person is standing indicates postural hypotension?

Answer 47

20mmHg or more

Question 48

If 3 BP measurements are taken in a clinic, which one should be recorded?

Answer 48

The lower of the last 2 measurements