1.12 - Hypertension

Question 1

What is the clinic and ABPM measurement for stage 1 hypertension

Answer 1

Clinical = 140/90
ABPM = 135/85

Question 2

What is the clinical and ABPM measurement for stage 2 hypertension

Answer 2

Clinic = 160/100
ABPM = 150/95

Question 3

What is the clinical measurement for stage 3 hypertension

Answer 3

Systolic > 180
Diastolic > 120

Question 4

What are the causes of secondary hypertension (ROPED)

Answer 4

Renal disease
Obesity
Pregnancy
Endocrine (Conns)
Drugs (NSAIDS, steroids, oestrogen)

Question 5

What is essential / primary hypertension

Answer 5

Idiopathic - no specific cause
90% of cases

Question 6

What are the complications of HTN

Answer 6

IHD
Cerebrovascular incident (stroke, haemorrhage)
Vascular disease
Hypertensive retinopathy
Hypertensive nephropathy
Vascular dementia
Left ventricular hypertrophy
Heart failure

Question 7

What investigations should be done following HTN diagnosis

Answer 7

ACR - proteinuria - kidney damage
Urinalysis - proteinuria, haematuria - kidney damage
HbA1c - diabetes
U&E - renal function
ECG - cardiac abnormalities

Question 8

What is the primary management for HTN

Answer 8

lifestyle changes - healthy diet, reduce alcohol, reduce caffeine, reduce stress, reduce salt, reduce smoking, reduce weight, increase exercise

Question 9

What medications are used for HTN (ABCD ARB)

Answer 9

ACE inhibitor (ramipril)
Beta blocker (bisoprolol)
Calcium channel blocker (amlodopine)
Thiazide like Diuretic (indapamide)
ARB (candesartan) (instead of ACEi if not tolerated)

Question 10

When is an ace inhibitor not first line for HTN, and what is used instead

Answer 10

If the patient is over 55, or black African
Calcium channel blocker used instead of

Question 11

If a patient is on ramipril their blood pressure does not go down, what medication should be added

Answer 11

Calcium channel blocker or thiazide like diuretic

Question 12

If a patient is on amlodipine and their blood pressure does not respond, what should they be given

Answer 12

Ace inhibitors or thiazide like diuretic

Question 13

If a patient is already taking ramipril and amlodipine what third medicine will they be given

Answer 13

Thiazide like diuretic

Question 14

What should be done with a patient on 3 agents whose blood pressure does not improve

Answer 14

Seek expert opinion to confirm diagnosis of resistant hypertension
Add fourth agent depending on serum potassium levels

Question 15

What is a hypertensive emergency

Answer 15

Accelerated or malignant hypertension >180/120, with retinal haemorrhages or papilloedema
Requires same day referral to hospital

Question 16

What is the management for a hypertensive emergency

Answer 16

IV:
sodium nitroprusside
Labetalol
Glyceryl trinitrate
Nicardipine

Should also be assessed for secondary causes and end organ damge