Hypertension

Question 1

What are the blood pressure measurements required to make a diagnosis of hypertension?

Answer 1

140/90mmHg

135/85mmHg (with home readings)

Question 2

What is the most common cause of hypertension?

Answer 2

Primary (essential) hypertension - 95%

Question 3

What are the secondary causes of hypertension?

Answer 3

Renal disease
Obesity
Pregnancy induced (pre-eclampsia)
Endocrine (Conn’s Syndrome)

ROPE

Question 4

What is the test for Conn’s syndrome?

Answer 4

Renin:Aldosterone ratio blood test

Question 5

What are the complications of hypertension

Answer 5

Ischaemic heart disease
Cerebrovascular accidents
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure

Question 6

How often should hypertension be screened for?

Answer 6

Every 5 years

Every year in patients with T2DM

Question 7

When should 24-hour ambulatory blood pressure monitoring be performed?

Answer 7

In patients with a clinic blood pressure reading between 140/90mmHg and 180/120mmHg

Home readings may also be used

Question 8

How is the ‘white coat effect’ defined?

Answer 8

More than a 20/10mmHg difference in blood pressure from clinic and ambulatory/home readings.

Question 9

What are the stages of hypertension?

Answer 9

Stage 1 hypertension: >140/90 (clinic)
>135/85 (ambulatory

Stage 2 hypertension: >160/100 (clinic)
>150/95 (ambulatory

Stage 3 hypertension: >180/120 (clinic)

Question 10

What investigations should patients with newly diagnosed hypertension receive to look for end-organ damage?

Answer 10

Urine albumin:creatinine ratio
Urine dipstick
HbA1c
Blood lipid levels
Renal bloods
Fundus examination
ECG

Question 11

What medications may be used to treat high blood pressure?

Answer 11

ACE inhibitor / ARBs
Beta blocker
Calcium channel blocker
Diuretics

Question 12

What class of drug does Ramipril belong to?

Answer 12

ACE inhibitors

Question 13

What class of drug does Bisoprolol belong to?

Answer 13

Beta blockers

Question 14

What class of drug does Amlodipine belong to?

Answer 14

Calcium-channel blockers

Question 15

What class of drug does Indapamide belong to?

Answer 15

Thiazide diuretics

Question 16

What class of drug does Candasartan belong to?

Answer 16

Angiotensin II Receptor Blocker (ARB)

Question 17

In what instances would candasartan be used instead of ramipril?

Answer 17

Intolerance (e.g. dry cough)

Patients of African or Afro-Caribbean descent

Question 18

Who is medical management for hypertension offered to?

Answer 18

All patients with stage 2 hypertension

Patients with stage 1 hypertension and a QRISK >10% or diabetes/CVD/renal disease (if under 80 years)

Question 19

What is the first line management for a 55 year old caucasian patient?

Answer 19

ACE inhibitor

Question 20

What is the first line management for a 56 year old caucasian patient?

Answer 20

Calcium-channel blocker

Question 21

What is the first line management for a 35 year old caucasian patient?

Answer 21

ACE inhibitor

Question 22

What is the first line management for a 65 year old caucasian patient?

Answer 22

Calcium-channel blocker

Question 23

What is the first line management for a 55 year old African patient?

Answer 23

Calcium-channel blocker

Question 24

What is the first line management for a 65 year old African patient?

Answer 24

Calcium-channel blocker

Question 25

What is the first line management for a 35 year old African patient?

Answer 25

Calcium-channel blocker

Question 26

What is the second line management for hypertension?

Answer 26

Addition of what was not offered in step one (therefore ACE inhibitor + Calcium-channel blocker)

Question 27

What is the third line management for hypertension?

Answer 27

Addition of a diuretic (e.g. Indapamide)

Question 28

What is the fourth line management for hypertension?

Answer 28

Addition of either: Potassium-sparing diuretic (if serum potassium is < 4.5mmol/L) Alpha-blocker or Beta-blocker (if serum potassium is > 4.5mmol/L)

Question 29

What class of drug does Doxazosin belong to?

Answer 29

Alpha blockers

Question 30

How does spironolactone work?

Answer 30

It blocks the action of aldosterone in the kidneys. This results in increased sodium excretion and potassium reabsorption.

Question 31

Which hypertension drugs may cause a hyperkalaemia?

Answer 31

Spironolactone ACE inhibitors ARBs

Question 32

What is the target blood pressure for a patient <80?

Answer 32

140/90mmHg

Question 33

What is the target blood pressure for a patient >80?

Answer 33

150/90mmHg