Cardiorespiratory – Hypertension

Question 1

Impression

Answer 1

Patient who presents with HTN, 95% will be essential HTN (primary). The remaining is caused by secondary causes . Patients should have BP assessed every 2-years.

• White coat HTN
• Primary hyperaldosteronism (Conn syndrome), phaeochromocytoma/thyroid, Cushing’s,
• Aortic coarctation, renal artery stenosis, renal disease, drugs (COCP, NSAID, steroids, alcohol, cyclosporin)
• Obesity, diet (e.g. liquorice intake)

Diagnosis of HTN can be via:

1) 1 x Severe HTN ≥180/100 mmHg – hypertensive urgency
2) 2 x clinic visits with ≥135/85mmHg or ≥140/90
3) 24-hr ambulatory BP monitoring (ABPM) average ≥130/80mmHg

Question 2

History

Answer 2

1) Hypertension – HOPC
Symptoms: cardiorespiratory symptoms,
Contributing/RF: SNAP RF, CVD RF, high salt diet, drugs (above, stimulants, antipsychotics)
Consequences: complications of HTN (head, eyes, chest, lung, kidneys)

2) Screen secondary causes
Drugs – non-compliance, above + caffeine, liquorice,
Endocrine symptoms of thyrotoxicosis, phaeochromocytoma, Obesity/OSA

3) General medical history, CVD risk assessment, GP screening

Question 3

Examination

Answer 3

• Vital signs (repeat BP), height/weight/BMI, waist circumference (<94cm men, <80cm women)
• Cardiovascular exam – signs of LVF/RVF, peripheral vascular exam
• End-organ damage – fundoscopy, bruits (carotid, renal artery), LVF/RVF,
• Signs of secondary causes of HTN – endocrine signs, radial-femoral delay

Question 4

Investigations

Answer 4

Bedside: ECG (previous ACS, LVH, arrhythmia),
urine (proteinuria, urine albumin:creatinine ratio in first void)
Risk assessment tools (absolute CVD risk)
Bloods: FBC, EUC, fasting lipids + BSL
investigate secondary causes
Plasma aldosterone: TSH,
Duplex U/S or CT renal angiogram (renal artery stenosis)

Question 5

Management

Answer 5

Confirm HTN (and exclude white-coat HTN) via 2nd reading or ABPM