6.3 Hypertension

Question 1

Define white coat hypertension

Answer 1

When a patient has an elevated BP in the clinic but not at home

Question 2

Define: Masked hypertension

Answer 2

a.k.a reverse white coat hypertension

Normal at the doctors clinic

Question 3

Define hypertension

Answer 3

repeatedly elevated BP (> 140/90)

Question 4

Factors of BP measurement

Answer 4

Use regularly ventilated and serviced device
measure BP on both arms for first time
ensure patient seated and relaxed
measure sitting and standing if orthostatic is suspected
Use right cuff size
repeat and average two readings

Question 5

Groups of high risk patients (>15% chance)

Answer 5

1. Patients aged over 75
2. Patients with pre-existing CV disease
3. patients with associated clinical conditions and/or end organ disease

Question 6

Aims of hypertension treatment

Answer 6

Reduce BP
Reduce absoloute CV risk
minimise end organ damage

Question 7

Lifestyle advice for patients with hypertension

Answer 7

30 mins moderate activity 
Stop smoking 
healthy weight 
Dietary salt restirction 
Limited alcohol (<1 women)

Question 8

Blood pressure targets

Answer 8

adults > 65 = < 65 = 130/85

Adults with 1g proteinuria: <125/75

Question 9

What is normal BP?

Answer 9

systolic < 120 diastolic <80

Question 10

Why might BP be resitant to treatment?

Answer 10

Non adherence
undiagnosed secondary hypertension
hypertensive effects of other drugs
treatment resistance due to sleep apnoea
undisclosed use of alcohol or recreational drugs
unrecognized high salt intake
volume overload, especially with chronic kidney disease
technical factors affecting measurement
white-coat hypertension