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Flashcards in Primary Hypertension Deck (21):
1

How is primary hypertension diagnosed?

Elevation over 140/90 on 3 occasions
If the first reading >150/95, repeat five minutes later
After the first reading, offer ambulatory monitoring
If denied, offer home blood pressure monitoring

2

What are the indications for an urgent referral in a patient with hypertension?

Signs of pheochromocytoma
Fundal haemorrhages
Papilloedema

3

Outline the ACD algorithm from the British Hypertensive Society for the treatment of hypertension

Less than 55: first step ACEI (or ARB if ACEI not tolerated)
Over 55 or Afro-Caribbean: first step calcium channel blocker

Step 2: ACEI and calcium channel blocker
Step 3: ACEI, calcium channel blocker, and thiazide diuretic
Step 4: Step 3 with the addition of another diuretic, alpha blocker or beta blocker
Consider specialist referral

4

What are the gradings for the severity of hypertension?

Clinic Readings:
Grade 1 (Mild) 140-159/90-99
Grade 2 (Moderate) 160-179/100-109
Grade 3 (Severe) >180/110

ABPM daytime average
Grade 1 (Mild) =>135/85
Grade 2 (Moderate) =>150/95

5

What are the common side effects of thiazide diuretics?

Gout
Poor glycaemic control
Hypercalcaemia
GI upset

6

What are the main contraindications for the use of thiazide diuretics?

Gout
Hypercalcaemia
Addison's disease
Hyponatraemia
Hypokalaemia

7

What are the common side effects of ACE Inhibitors?

Hypotension
Dry, hacking cough
Hyperkalaemia
Rash
GI upset
Drug induced angioedema
Deranged LFTs

8

What are the main contraindications for the use of ACE Inhibitors?

Hypersensitivity to ACE Inhibitors
Renal failure with creatinine greater than 200
Renal artery stenosis
Aortic stenosis

9

What are the common side effects of Angiotensin Receptor Blockers?

Dizziness
Hyperkalaemia
Angioedema

10

What are the main contraindications for the use of ARBs?

Hypersensitivity to ACE Inhibitors
Renal failure with creatinine greater than 200
Renal artery stenosis
Aortic stenosis
Cholestatis

11

What are the common side effects of calcium channel blockers?

Abdominal pain
Nausea
Palpitations
Flushing
Oedema
Dizziness
Headache

12

What are the main contraindications for the use of calcium channel blockers?

Uncontrolled heart failure
Severe aortic stenosis
Porphyria

13

What are the common side effects of B blockers?

GI upset
Bradycardia
Peripheral vasoconstriction ( worsening of claudication and Raynaud's)
Bronchospasm
Headache
Sexual dysfunction

14

What are the main contraindications for the use of B blockers?

Pheochromocytoma
Asthma
Uncontrolled heart failure
Sick sinus syndrome
Second or third degree heart block
Peripheral arterial disease

15

What are the indications for the treatment of Grade 1 (mild) hypertension?

End organ damage (urine dipstick and ECG)
Established CV disease
CKD stage 3 or above
Diabetes
10 year cardiovascular risk equal or more than 20%

16

What are the features of hypertensive retinopathy?

There are four stages outlined in the KWB grades:
1. Torturous arteries with thick, shiny walls
2. A-V nipping
3. Flame haemorrhages and cotton wool spots
4. Papilloedema

17

What is meant by malignant hypertension?

Sustained increase in blood pressure >= 200/120mmHg associated with severe retinopathy (grade 3/4)

Symptoms include headaches, blurred vision, dizziness

18

What treatment is required in malignant hypertension?

With severe disease
ITU admission
IV sodium nitroprusside and frusemide
Lower BP by 25% over the first two hours (slow to prevent cerebral hypoperfusion)
Then BP to normal over the next 72hrs
When stable investigate for secondary causes

19

What is the mechanism of action of moxonidine?

Centrally acting (medulla oblongata) anti-hypertensive
Imidazolone receptor subtype 1
Decrease in SNS activity to decrease BP

20

What monitoring is required when starting/changing the dose of an ACE inhibitor/ARB?

eGFR decreases by 25% or Cr increases by 30% (limit)
Continue and recheck in 1-2/52
If sustained, and no other cause is identified, stop/reduce back to the previous dose

21

Why are ACE inhibitors contraindicated in pregnancy?

They may adversely affect foetal and neonatal BP control and renal function, possible skull defects and oligohydramnios