Essential or secondary hypertension

Question 1

NICE definition of HTN

Answer 1

Clinic reading persistently >140/90

24 hour reading >135/85

Question 2

Primary/ essential HTN

Answer 2

No single disease causing the rise in BP

Complex physiological changes which occur with age

Question 3

Secondary HTN

Answer 3

Caused by a wide range of endocrine, renal and other causes

Question 4

Renal causes of HTN

Answer 4

Glomerulonephritis

Chronic pylenonephritis

Adult polycystic kidney disease

Renal artery stenosis

Question 5

Endocrine causes of HTN

Answer 5

Primary hyperaldosteronism

Phaeochromocytoma

Cushing’s syndrome

Liddle’s syndrome

Congenital adrenal hyperplasia

Acromegaly

Question 6

Other causes of HTN

Answer 6

Glucocorticoids

NSAIDs

Pregnancy

Coarctation of the aorta

COCP

Question 7

Symptoms

Answer 7

Typically no symptoms unless BP very high

Headaches, visual disturbances, seizures

Question 8

Complications of HTN

Answer 8

IHD

Cerebrovascular accident

Hypertensive retinopathy

Hypertensive nephropathy

Heart failure

Question 9

Assessing end-organ damage

Answer 9

Fundus examination for retinopathy

Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria for nepthropathy

Bloods for HbA1c, renal function and lipids

ECG for cardiac abnormalities

Question 10

Medical management step 1

Answer 10

Aged <55 and non-black use ACEi

Aged >55 or black of African or African-Caribbean descent use calcium channel blocker

Question 11

Step 2

Answer 11

ACEi and CCB or thiazide like diuretic OR

CCB and ACEi/ARB or thiazide like diuretic

If black then use ARB instead of ACEi

Question 12

Step 3

Answer 12

ACEi/ARB + CCB + thiazide like diuretic

Question 13

STep 4

Answer 13

Same as three plus an additional agent

K+<4.5 use potassium sparing diuretic

K+>4.5 use an alpha blocker or beta blocker

Question 14

Treatment targets

Answer 14

<80 aim for <140/<90

> 80 aim for <150/<90