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Define hypertension

BP equal or greater than 140/90


What is the diagnostic criteria for orthostatic hypertension?

A drop in either, after standing for three minutes:

  • SBP of 20+ mmHg
  • DBP of 10+ mmHg


List five causes of hypertension

  • Essential hypertension: Unknown cause
  • Secondary hypertension:
    • Renal artery stenosis, renal parenchymal disease eg. ADPKD
    • Conn's syndrome, Phaechromocytoma, Hyperthyroidism, Cushing's syndrome, Acromegaly
    • Coarctation of aorta, pregnancy, exogenous steroids, MAOi (tyramine)


How is hypertension diagnosed?

  • Initial BP ≥140/90 mmHg is offered Ambulatory BP monitoring (ABPM)
    • Home BP monitoring can also be used.
  • HTN if both:
    • Clinic BP is ≥140/90 mmHg
    • Daytime average ABPM is ≥135/85 mmHg


Describe the stages of hypertension

  1. Clinic BP 140/90+, and Daytime average ABPM 135/85+
  2. Clinic BP 160/100+, and Daytime average ABPM 150/95+
  3. [Severe] Clinic SBP 180+, or Clinic DBP 110+


Provide three examples of target organ damage in hypertension

  • Blood vessel: Atherosclerosis, aneurysm, aortic dissection
  • CKD: Haematuria, uraemia, proteinaemia
  • Heart failure: Pulmonary oedema, MI, LV hypertrophy
  • CVA: Haemorrhage/infarction, seizures, vascular dementia
  • Hypertensive retinopathy


Request three investigations whilst awaiting ABPM/HBPM results for hypertension?

Investigations for target organ damage:

  • Urinalysis: protein, ACR, haematuria
  • Bloods: glucose, electrolytes, creatinine, eGFR, total and HDL cholesterol
  • Fundoscopy: hypertensive retinopathy
  • 12-lead ECG: LV hypertrophy
  • QRISK2


Which patients should be referred to specialist care on the same day?

  • Accelerated HTN: BP >180/110 with papilloedema and/or retinal haemorrhage
  • Phaechromocytoma: HTN, headaches, palpitations, pallor, sweating, postural hypotension


Outline the classification of hypertensive retinopathy

  1. Tortuous arteries with increased reflectiveness (silver wiring)
  2. Grade I + AV nipping
  3. Grade II + Flame haemorrhages and cotton wool spots
  4. Grade III + Papilloedema (blurred optic disc margin)


Give four lifestyle modifications for the management of hypertension

  • Low salt diet
  • Low alcohol and caffeine intake
  • Smoking cessation
  • Exercise; weight control
  • Minimise stress.


What are the indications for starting antihypertensives?

  • Stage 1 HTN if <80yr with any of:
    • Target organ damage
    • CVD
    • Renal disease
    • Diabetes
    • 10-year CVD risk ≥10%:
  • Stage 2 HTN for any age


Outline the choice of antihypertensives and BP targets