Cardiology: Hypertension Flashcards
What is the NICE diagnosis of
hypertension [1]
BP above 140/90 in a clinical setting confirmed with ambulatory or home readings above 135/85
Describe the aetiological factors that cause secondary HTN? [6]
Essential hypertension: 90%
- Unknown cause
Secondary hypertension:
R enal disease
O besity
P regnancy induced / pre-eclampsia
E ndocrine
D rugs
Which renal disease are significantly contribute to causing HTN? [6]
- Diabetes nephropathy
- Glomerulonephritis
- Chronic pyelonephritis
- Renal cell carcinoma
- Adult polycystic kidney disease
- Renal artery stenosis
Which endocrine disorders significantly contribute to causing HTN? [6]
- Primary hyperaldosteronism (Conns)
- Phaechromocytoma
- Cushings
- Liddles syndrome
- Congenital adrenal hyperplasia (11 beta-hydroxylase deficiency)
- Acromegaly
Which drugs cause hypertension? [8]
- Alcohol
- Cocaine
- Combined oral contraceptive pill
- Erythropoietin
- NSAIDs
- Corticosteroids
- Venlafaxine (an antidepressant medication of the serotonin-norepinephrine reuptake inhibitor class)
- Oestrogens used in HRT
What investigation should you perform if you consider renal artery stenosis is causing HTN? [1]
Duplex ultrasound
MR or CT angiogram
Describe the cardiac complications of hypertension [1]
How would you detect this on a examination? [1]
May develop LV hypertrophy; causing sustained and forceful apex beat
What symptoms might patients present with when suffering from hypertension?
Often asymptomatic / symptoms only present when > 200/120mmHg
- Headaches
- Visual disturbance
- Seizures
Describe how you would make a diagnosis of HTN? [1]
BP above 140/90 in a clinical setting confirmed with ambulatory or home readings above 135/85 frr 24 hrs
NICE rec. both arms and if the difference is more than 15mmHg use higher BP
What are the different stages of HTN? [3] (include both clinic and home readings)
Stage 1:
- Clinic: >140/90
- Home / Ambulatory: Above 135/85
Stage 2:
- Clinic: >160/100
- Home / Ambulatory: Above 150/90
Stage 3:
- Clinic: >180/120
NICE recommends all patients who are newly diagnosed with hypertension to have which checks to investigate for end organ damage? [4]
Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess for kidney damage
Bloods for HbA1c, renal function and lipids
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities, including left ventricular hypertrophy
What score would you also calculate on a new diagnosis of HTN? [1]
QRISK
A patient is newly diagnosed with HTN.
A QRISK is performed and their risk of cardiac events is calculated at 14%.
What treatment should you give? [1]
Offer atorvastatin 20mg daily (at night)
Which drugs are used in the general management of HTN? [5]
(non-specific to patient populations)
A – ACE inhibitor (e.g., ramipril)
B – Beta blocker (e.g., bisoprolol)
C – Calcium channel blocker (e.g., amlodipine)
D – Thiazide-like diuretic (e.g., indapamide)
ARB – Angiotensin II receptor blocker (e.g., candesartan)
Describe the specific management plans for treating HTN for patients who are Over 55 / NO DMT2 / Black or Afro-Caribbean [4]
Over 55 / NO DMT2 / Black or Afro-Caribbean:
STEP 1:
- CCB
STEP 2:
- CCB and ACE inhibitor
OR
- CCB and Thiazide-like diuretic
STEP 3:
ACE inhibitor and CCB and Thiazide-like diuretic
STEP 4:
- If K ≤4.5 add low dose spironolactone
- If K ≥4.5 add alpha blocker or beta blocker
- If not controlled with 4 drugs: specialist review
Describe the specific management plans for treating HTN for patients who are under 55 / DMT2 [4]
STEP 1:
- ACEin / ARB
STEP 2:
- CCB and ACEin / ARB
OR
- ACEin / ARB and Thiazide-like diuretic
STEP 3:
ACE inhibitor and CCB and Thiazide-like diuretic
STEP 4:
- If K ≤4.5 add low dose spironolactone
- If K ≥4.5 add alpha blocker or beta blocker
- If not controlled with 4 drugs: specialist review
When should you prioritise an ARB over an ACE inhibitor?
If cough present in ACEin
What is step 4 of the hypertensive treatment plan? [4]
STEP 4:
- If K ≤4.5 add low dose spironolactone
- If K ≥4.5 add alpha blocker or beta blocker
- If not controlled with 4 drugs: specialist review
CCBs all cause which side effect? [1]
Gum hypertrophy!
a. According to NICE, how many blood pressure measurements should be taken during a single visit for accurate diagnosis?
A. One
B. Two
C. Three
D. Four
a. According to NICE, how many blood pressure measurements should be taken during a single visit for accurate diagnosis?
A. One
B. Two
C. Three
D. Four
Describe how you would manage a patient who presents with BP of 180/120 mmHg or more [3]
Refer for same-day specialist review if:
* retinal haemorrhage or papilloedema
(accelerated hypertension) or
* life-threatening symptoms or
* suspected pheochromocytoma
If target organ damage, consider starting drug treatment immediately without ABPM/HBPM
If no target organ damage, confirm diagnosis by:
* repeating clinic blood pressure measurement within 7 days, or considering monitoring using ABPM/
* HBPM and ensuring a clinical review within 7 days
