Chronic diseases: Hypertension Flashcards

Question

Features of secondary hypertension - Cushing's, Drug-indiced, diet, EPO-induced, Thyroid disorders

Answer 1

Physical examination * Body weight, height, Body Mass Index * Features of Cushing’s syndrome / Acromegaly (endocrine case of HT) * Skin stigmata of neurofibromatosis (phaeochromocytoma) * Radial/brachial femoral delay, precordial or chest murmurs (aortic coarctation or aortic disease) * Abdominal examination: enlarged kidney, abdominal bruit * Signs of organ damage: peripheral arterial disease, fundi abnormalities, carotid bruit, neurological defects, CVS examination

Answer 2

The DASH eating plan has the following characteristics: * Rich in fruits, vegetables * Rich in potassium, magnesium and calcium * Low in cholesterol, saturated and total fat * Low in sodium * Low in sweets and added sugars Key points: - Sodium: <5g per day - Potassium rich food from fruit and vegetables (unless CKD or K+ diuretics) - Complex carbohydrate with high fiber foods for 50% energy intake - 4-5 servings of fruit and vegetables per day - Lean protein for 20% total energy intake - Fat for <30% energy intake with low saturated fat and low cholesterol, trans fat - Alcohol consumption: <2 unit/ day for man, <1 unit per day for woman

Answer 3

Frequency: Aerobic on all days, resistance 2-3x per week Intensity: Aerobic at moderate intensity (40-60% VO2 max or 50-70% max heart rate) Time: 30-60 mins aerobic per day, 8-10 types of resistance exercise with 1 set minimum each Type: Aerobic i.e. walking, jogging, cycling and swimming, rope skipping Resistance: Machine or free weight Risks and precaution: - Intensive isometric exercise such as heavy weight lifting can have a marked pressor effect and should be avoided - If hypertension is poorly controlled, heavy physical exercise as well as maximal exercise testing should be discouraged or postponed until appropriate drug treatment has been instituted and blood pressure lowered - Keep BP <220/105 during exercise - B-blocker and diuretic users: risk of hypoglycaemia and hyperthermia - CCB, a-blockers and vasodilator users: sudden post-exercise hypotension - Monitor for cardiac prodromal symptoms

Answer 4

Lifestyle modification - Reduction of dietary fat intake - Total fat <30% of total calorie/day - Saturated fat <7%, cholesterol <200 mg, trans fat <1% of total calorie intake/day Drug treatment: - Statin - Fibrate (no strong evidence for using fibrate therapy in primary prevention of cardiovascular disease. The use of fibrates in these patients should only be considered when statins are contraindicated) - Ezetimibe ( add-on drug in association with statins when the therapeutic target is not achieved at the maximum tolerated statin dose, or as an alternative to statins in patients who are intolerant of statins or with contraindications to statins)