Hypertension

Question 1

What is primary hypertension?

Answer 1

No underlying cause. Strong polygenic familial trend, environmental factors. 95%

Question 2

What is secondary hypertension? What might cause it? (4)

Answer 2

Result of underlying condition. 5%. Coarctation of the aorta, renal disease, endocrine problem, drugs.

Question 3

What renal diseases may result in hypertension? (3)

Answer 3

Renovascular issues, glomerulonephritis, obstructive uropathy

Question 4

What endocrine issues may be a cause of hypertension? (5)

Answer 4

Conn’s (hyperaldosteronism), Cushing’s (hypercortisolism), phaeochromocytoma, acromegaly, carcinoid

Question 5

What drugs may be the cause of hypertension? (3)

Answer 5

Alcohol, corticosteroids, NSAIDs

Question 6

What symptoms could be caused by hypertension? (6)

Answer 6

Usually asymptomatic. Visual disturbances, headaches, shortness of breath, chest pain, palpitations, urinary symptoms

Question 7

What examinations would you do post diagnosis of hypertension? (4)

Answer 7

Fundoscopy, CR exam, chest exam, abdo exam

Question 8

What examinations would you carry out to check for coarctation? (4)

Answer 8

Physical exam, chest radiograph, echocardiogram, CT/MRI of aorta

Question 9

What examinations would you carry out to look for renal causes? (3)

Answer 9

Renal USS, CT/MRI of kidneys/ bloody supply, renal artery Doppler

Question 10

How would you investigate for Conn’s?

Answer 10

Plasma renin activity, aldosterone

Question 11

How would you investigate for Cushing’s?

Answer 11

Overnight dexamethasone, 24hr urine cortisol

Question 12

How would you investigate for a drug related cause?

Answer 12

Urine, toxicology

Question 13

How is hypertension diagnosed? (3)

Answer 13

Clinic BP >140/90. ABPM- measures over 24hrs. HBPM- 2 consecutive a day >1 min apart 2x a day for > 4 days. Avg not including first day

Question 14

What is stage 1 hypertension?

Answer 14

BP>140/90 in clinic and ABPM/ HBPM mean >135/85

Question 15

What is stage 2 hypertension?

Answer 15

Clinic BP >160/100. ABPM/ HBPM mean > 150/95

Question 16

What is severe hypertension?

Answer 16

Clinic SBP>180 or DBP>110.

Question 17

How would you treat stage 1 hypertension?

Answer 17

Offer lifestyle interventions and education unless target organ damaged (+antihypertensive) or under 40 (specialist referral)

Question 18

What BP is aimed for during treatment?

Answer 18

Under 80 <140/90. Over 80 <150/90

Question 19

When is an ACE inhibitor not frontline treatment for hypertension?

Answer 19

African/ Caribbean any age or over 55s . CCB first then add ACE inhibitor

Question 20

What is postural hypotension?

Answer 20

Decrease when standing of more than 20 systolic and 10 diastolic

Question 21

How would you manage postural hypotension? (4)

Answer 21

Less rigid control of hypertension. Elevate head of bed, use water as vasopressor. Improve venous return eg with compression stockings

Question 22

What are 4 conditions in pregnancy associated with blood pressure?

Answer 22

Gestational hypertension- after 20 weeks. Add proteinuria = pre-eclampsia. Eclampsia- convulsive condition associated with former. Chronic hypertension if pre existing.

Question 23

What are the potential consequences of not treating these conditions during pregnancy?

Answer 23

Increased perinatal mortality, preterm birth, low birth weight

Question 24

What is the aim for hypertension in pregnancy?

Answer 24

<150/100 or <140/90 if organ damage

Question 25

If the mother is diabetic, has CKD, hypertension, problems in previous pregnancy, what would you give her?

Answer 25

75mg aspirin 12 weeks to birth

Question 26

What antihypertensives are contraindicated in pregnancy? (3 types)

Answer 26

ACE inhibitors, ARBs, chlorothiazide. They are teratogenic