Hypertension

Question 1

A blood pressure of what is the most widely accepted definition of hypertension?

Answer 1

More than 140mmHg systolic and/or 90mmHg diastolic

Question 2

Which ethnic group has the highest prevalence of hypertension?

Answer 2

Afro-Caribbean

Question 3

What are some modifiable risk factors for hypertension?

Answer 3

Obesity, smoking, alcohol, high salt intake

Question 4

If a patient has a one-off blood pressure reading of > 140/90 in clinic, what should you do next?

Answer 4

Repeat the test (if the second reading varies a lot from the first, repeat it again)

Question 5

What investigation must be done in order to diagnose hypertension?

Answer 5

Home or ambulatory blood pressure monitoring

Question 6

On home or ambulatory blood pressure monitoring, what result would be diagnostic of hypertension?

Answer 6

An average waking blood pressure of > 135/85mmHg

Question 7

What is a vascular condition which can cause secondary hypertension?

Answer 7

Coarctation of the aorta

Question 8

What are some medications that can cause secondary hypertension?

Answer 8

HRT/COCP, steroids, NSAIDs

Question 9

What is the definition of accelerated hypertension?

Answer 9

BP > 180/110mmHg in combination with severe retinopathy

Question 10

What medications can potentially be used in cases of hypertensive emergencies?

Answer 10

IV labetalol or GTN

Question 11

What is the definition of malignant hypertension? What clinical sign can be seen in these cases?

Answer 11

Diastolic pressure > 130-140mmHg / papilloedema

Question 12

If an ACE inhibitor, Ca channel blocker and thiazide diuretic are not adequately controlling hypertension, and the potassium level is < 4.5mmol/L, what drug(s) should be considered next?

Answer 12

Low dose spironolactone

Question 13

If an ACE inhibitor, Ca channel blocker and thiazide diuretic are not adequately controlling hypertension, and the potassium level is > 4.5mmol/L, what drug(s) should be considered next?

Answer 13

Alpha or beta blocker

Question 14

What drug is especially effective for treating resistant hypertension?

Answer 14

Spironolactone

Question 15

What is a fairly common side effect of ACE inhibitors? If this occurs, what group of drugs should be used instead?

Answer 15

Dry cough / ARB

Question 16

What is the target blood pressure in adults aged < 80?

Answer 16

< 140/90

Question 17

What is the target blood pressure in adults aged > 80?

Answer 17

< 150/85

Question 18

What is the target blood pressure in adults with diabetes?

Answer 18

< 130/80

Question 19

Which organ systems are most likely to be affected by hypertension?

Answer 19

Cardiovascular, renal, neurological and ophthalmic

Question 20

What side effect of the use of anti-hypertensive medications is very common in the elderly?

Answer 20

Postural hypotension

Question 21

What are some drugs that can be used to manage hypertension in pregnancy?

Answer 21

Labetalol, nifedipine, hydralazine, methyldopa

Question 22

Metabolic syndrome can be diagnosed when 3 out of what 4 features are present?

Answer 22

Obesity, hypertension, dyslipidaemia, insulin resistance

Question 23

What are some features that would make you suspicious of secondary hypertension?

Answer 23

Early onset (< 40), unexpectedly severe, resistant hypertension

Question 24

What are some renal causes of secondary hypertension?

Answer 24

CKD, renal artery stenosis, PKD

Question 25

What are some endocrine causes of secondary hypertension?

Answer 25

Phaeochromocytoma, Conn's syndrome, Cushing's syndrome

Question 26

What is some lifestyle advice that should be offered to patients with hypertension?

Answer 26

Lose weight, exercise, stop smoking, reduce alcohol, low salt diet (ideally to < 6g/day)

Question 27

What is a common cause of apparently resistant hypertension?

Answer 27

Non-compliance with medication

Question 28

What is the first line drug for the management of hypertension in those aged < 55?

Answer 28

ACE inhibitor / ARB

Question 29

What is the first line drug for the management of hypertension in those aged > 55?

Answer 29

Ca channel blocker

Question 30

What is the first line drug for the management of hypertension in those of Afro-Caribbean origin (of any age)?

Answer 30

Ca channel blocker

Question 31

What is the first line drug for the management of hypertension in diabetics (of any age)?

Answer 31

ACE inhibitor / ARB

Question 32

If a single drug agent is not adequately controlling hypertension, what should be done next?

Answer 32

Combine two of the following: ACE inhibitor, Ca channel blocker, thiazide diuretic

Question 33

If two drugs are not adequately controlling hypertension, what should be done next?

Answer 33

Combine an ACE inhibitor, Ca channel blocker and thiazide diuretic

Question 34

A 10 year CV risk of what is considered significant? In Scotland, what tool can be used to calculate this risk?

Answer 34

> 20% / ASSIGN score

Question 35

When a patient is newly diagnosed with hypertension, what other investigations are required to assess their risk of cardiovascular disease?

Answer 35

Fasting blood glucose and lipid profile

Question 36

When a patient is newly diagnosed with hypertension, what other investigations are required to look for evidence of target organ damage?

Answer 36

ECG, U&Es and urinalysis, fundoscopy

Question 37

What are the two general principles of management of hypertension?

Answer 37

Lifestyle modifications and drug treatment