Cardio - HTN

Question 1

What is stage 1 hypertension? What important factors must you consider in your treatment?

Answer 1

Clinic BP>= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

-Treat if <80 ya of age AND any of following apply: target organ damage, established CVS disease, renal disease, diabetes or 10-year CVS risk equivalent to 20% or greater

Question 2

What is stage 2 hypertension? What factors must you consider when thinking of treatment?

Answer 2

• Clinic BP >= 160/100 and subsequent ABPM daytime average of HBPM average BP >= 150/95
• Offer Rx regardless of age

Question 3

What is severe (stage 3) hypertension?

Answer 3

-Clinic systolic >=180 mmHg or clinic diastolic >= 110 mmHg

Question 4

What must you do for pts <40 ho have HTN?

Answer 4

-Refer to specialist to look for 2ndary causes

Question 5

What are the clinic BP and ABPM targets for patients below and above 80 years old

Answer 5

• Age <80: 140/90 mmHg (clinic) and 135/85 mmHg (home/ambulatory)
• Age >80: 150/90 mmHg and 145/85 mmHg (home/ambulatory)

Question 6

What lifestyle advice should you give to manage HTN?

Answer 6

• Low salt diet (aim <6g/day, ideal 3G/day)
• Reduce caffeine intake
• General advice: stop smoking, drink less alcohol, balanced diet, exercise more, lose weight

Question 7

HTN Mx: step 1

Answer 7

• Patients <55 years old: ACE inhibitor - ramipril

- Patients >=55 years old or Afro-Caribbean: CCB (or ARB if cannot tolerate)

Question 8

HTN Mx: step 2

Answer 8

-ACE I + CCB

Question 9

HTN Mx: step 3

Answer 9

• ACEe + CCB
• Add thiazides diuretic: eg bendroflumethiazide
• *NICE now advocate using thiazides like diuretic: chlorthalidone (12.5-25mg OD) or indapamide (1.5mg modified release OD or 2.5mg OD) in preference to congenital thiazide diuretic

Question 10

HTN Mx: step 4

• At what stage do you consider pt to have resistant HTN?
• What is step 4?

Answer 10

• Clinic BP >= 140/90 mmHg after step 3 = resistant HTN
• Need to escalate to step 4 or seek expert advice

Step 4
-Further diuretic Rx:
K+<4.5 mmol/L add spironolactone 25mg OD
K+>4.5 mmo/L add higher-dose thiazide-like diuretic rx
-IF further diuretic rx not tolerated/CI/ineffective - consider alpha blocker or beta blocker