55. Hypertension

Question 1

Secondary causes of HTN: renal

Answer 1

• Chronic pyelonephritis — usually detected unexpectedly on ultrasonography when investigating hypertension.
• Diabetic nephropathy — indicated by microalbuminuria or proteinuria.
• Glomerulonephritis — often indicated by microscopic haematuria.
• Polycystic kidney disease — suggested by an abdominal or flank mass, microscopic haematuria, or family history.
• Obstructive uropathy — the person may have an abdominal or flank mass.
  Renal cell carcinoma — classically the person may have haematuria, loin pain and a loin mass,

Question 2

Secondary causes of HTN: vascular
a) Difference in BP between left and right arms; weak femoral pulses with radio-femoral delay. Suprasternal murmur radiating into the back

b) Patient with PVD and abdominal bruit with elevated serum renin; what treatment is contraindicated in this disease?

Answer 2

a) Coarctation of the aorta

b) Renal artery stenosis. ACE inhibitors contraindicated

Question 3

Secondary causes of HTN: endocrine

a) Hypokalaemia, alkalosis. How to manage?
b) Headaches, sweating attacks, palpitations, or unexplained fever and abdominal pain
c) Weight gain, striae, hyperglycaemia
d) Enlargement of hands and feet, facial changes, sweating
e) Increased diastolic BP, fatigue, weight gain, dry skin and hair loss, constipation, and muscle weakness
f) Increased systolic BP, tremor, anxiety, sweating, weight loss, diarrhoea, and heat intolerance

Answer 3

a) Hyperaldosteronism (e.g. Conn’s syndrome) - CT abdomen and resection of any adrenal adenoma
b) Phaeochromocytoma
c) Cushing’s
d) Acromegaly
e) Hypothyroidism
f) Hyperthyroidism

Question 4

Hypertension in pregnancy.

a) Pre-existing HTN - define
b) Gestational HTN - define
c) Pre-eclampsia - define
d) HELLP syndrome
e) Eclampsia
f) 1st choice anti-hypertensive. (2 alternatives)

Answer 4

a) HTN presenting prior to 20 weeks gestation
b) New HTN presenting after 20 weeks gestation WITHOUT significant proteinuria
c) New HTN presenting after 20 weeks gestation AND significant proteinuria
d) Haemolysis, Elevated Liver enzymes, and Low Platelets syndrome: a severe form of pre-eclampsia
e) Occurrence of seizures in a woman with pre-eclampsia

f) Labetalol. 2nd line: nifedipine or methyldopa
(ACEI/ARBs are absolutely contraindicated)

Question 5

Women at-risk of pre-eclampsia: management

a) Monitoring
b) TCI if experiencing what symptoms?
c) Drug management

Answer 5

a) Monitor BP and proteinuria (urine dip) at every antenatal visit

b) - Severe headaches (increasing frequency unrelieved by regular analgesics).
- Vision problems, such as blurred vision, flashing lights, double vision, or floating spots.
- Persistent new epigastric/RUQ pain
- Vomiting.
- Breathlessness.
- Sudden swelling of the face, hands, or feet

c) Low-dose aspirin (75mg) from 12 weeks gestation until delivery