Essential or Secondary Hypertension Flashcards
Hypertension is defined as a blood pressure >140/90, with home ambulatory readings >135/85mmHg. This can be divided into:
Primary = no known cause
Secondary = specific cause identified
Is primary or secondary hypertension more common?
- Primary accounts for 90% of all hypertension
Primary is also called essential hypertension
What is the incidence of primary/essential hypertension?
1 - 10,000 cases per 100,000
2 - 1000 cases per 100,000
3 - 100 cases per 100,000
4 - 10 cases per 100,000
2 - 1000 cases per 100,000
Equally as likely in men and women
What age does the incidence of primary/essential hypertension peak?
1 - 30-40
2 - 40-50
3 - 50-60
5 - 60-70
3 - 50-60
Which of the following is NOT a cause of secondary hypertension?
1 – Renal disease
2 – Obesity
3 – Pregnancy-induced hypertension or pre-eclampsia
4 – Endocrine (hyperaldosteronism (Conns syndrome))
5 – Drugs (e.g., alcohol, steroids, NSAIDs, oestrogen and liquorice)
6 - Inactivity
6 - Inactivity
Linked, but not a specific cause
Use the mnemonic ROPED to remember this
Hyperaldosteronism increases BP by retaining more Na+ and H2O
What is the most common cause of secondary hypertension?
1 – Renal disease
2 – Obesity
3 – Pregnancy-induced hypertension or pre-eclampsia
4 – Endocrine (hyperaldosteronism)
5 – Drugs (e.g., alcohol, steroids, NSAIDs, oestrogen and liquorice)
1 – Renal disease
If BP is very high or unresponsive to medication, consider renal artery stenosis, can diagnose using duplex ultrasound or an MR or CT angiogram.
Hyperaldosteronism, often referred to as Conns syndrome is the most common endocrine dysfunction causing an increase in BP. This can result in elevated BP that is unresponsive to BP medications. How can this be diagnosed most effectively?
1 - ultrasound
2 - renin:aldosterone ratio
3 - ADH levels
4 - urine osmolarity
2 - renin:aldosterone ratio
Which of the following secondary causes of hypertension is responsible for secreting excess hormones from the adrenal gland that causes a systemic increase in BP?
1 - Hyperaldosteronism
2 - Phaeochromocytoma
3 - Diabetes
4 - Acromegaly
2 - Phaeochromocytoma
Rare tumour secreting noradrenaline and adrenalin
Although the exact cause of primary/essential hypertension has been fully identified, which of the following have been implicated?
1 - Genetic Factors
2 - Neural Mechanisms
3 - Renal Mechanisms
4 - Endocrine and Hormonal Mechanisms
5 - Vascular Mechanisms
6 - Lifestyle Factors
7 - All of the above
7 - All of the above
- Neural Mechanisms = increased sympathetic activity, HR, vasoconstriction and renin release by kidney’s
- Renal Mechanism = altered eGFR and RAAS system
- Endocrine and Hormonal Mechanisms = dysfunctional RAAS, increased angiotensin II and aldosterone
- Vascular Mechanisms = structural (atherosclerosis) and impaired vasodilation
- Lifestyle Factors = excess salt, alcohol, tobacco, lwo activity
Which of the following is NOT a common complication of hypertension?
1 - IHD
2 - stroke / cerebral bleeds
3 - Vascular disease (PAD, aneurysm)
4 - Hypertensive retinopathy and nephropathy
5 - Vascular dementia
6 - Left ventricular hypertrophy
7 - Liver cirrhosis
8 - Heart failure
7 - Liver cirrhosis
Does hypertension typically cause symptoms?
- No
Although patients do not typically have symptoms with high blood pressure, if the BP is very high, they can present with which of the following?
1 - headaches
2 - visual disturbance
3 - seizures
4 - all of the above
4 - all of the above
According to NICE guidelines, how often should blood pressure be monitored to detect hypertension nonlow risk and non-type 2 diabetics?
1 - every 10 years
2 - every 5 years
3 - every 2 years
4 - annually
3 - every 2 years
More often in type 2 diabetes and high risk patients
If a patient presents with a high BP in the surgery, prior to any medications they should be asked to have 24h ambulatory monitoring or monitoring at home. To have this what must the temperature fall between in the GP surgery?
1 - 120/80 mmHg and 180/120 mmHg
2 - 135/90 mmHg and 160/120 mmHg
3 - 140/90 mmHg and 200/140 mmHg
4 - 140/90 mmHg and 180/120 mmHg
4 - 140/90 mmHg and 180/120 mmHg
Patients may be referred to be seen on the same day for cardiac assessment if the BP is above what?
1 - diastolic >100 mmHg
2 - diastolic >120 mmHg
3 - systolic >160 mmHg
4 - systolic >180 mmHg
4 - systolic >180 mmHg
Refer for same-day specialist review if:
* retinal haemorrhage or papilloedema
(accelerated hypertension) or
* life-threatening symptoms or
* suspected pheochromocytoma
Once a patient is confirmed as having hypertension, they are staged as follows:
Stage 1 Hypertension = >140/90 or 135/85 at home
Stage 2 Hypertension = >160/100 or >150/95 at home
Stage 3 Hypertension - >180/120
All of the following are routinely performed to assess for end organ damage, exceopt which of the following?
1 - fundoscopy
2 - urine dipstick
3 - peripheral nerve exam
4 - ECG
5 - bloods
3 - peripheral nerve exam
- Urine also measures albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess for kidney damage
- Bloods for HbA1c, renal function and lipids
- ECG for left
In patients who are being assessed for hypertension, a Q-risk score should also be calculated, which is a predictor for the risk of having a stroke or MI in the next 10 years. A score above what would be an indicator to begin a statin?
1 - >1%
2 - >5%
3 - >10%
4 - >25%
3 - >10%
Simvastatin and Atorvastatin are very common drugs used
The 1st line statin is typically atorvastatin at 20mg. When should statins be taken?
1 - PO
2 - same time each day, determined by the patient
3 - morning with food
4 - at night
4 - at night
Most cholesterol is made in the evenings
Lifestyle advice including which of the following should be given to all patients at risk of hypertension?
1 - healthy diet
2 - stopping smoking
3 - reducing alcohol
4 - reducing caffeine and salt intake
5 - regular exercise
6 - all of the above
6 - all of the above
Which 2 of the following medications is 1st line in patients with hypertension and diabetes AND caucasians aged <55 y/o according to NICE guidelines?
1 - ramipril
2 - spirolactone
3 - bisoprolol
4 - losartan
1 - ramipril
4 - losartan
ACE or ARB inhibitors are 1st line for diabetic patients with hypertension
ACE = Ramipril, Lisinopril, Enalapril
ARB = Candesartan, Losartan
If an ACE or ARB fails to control a patient with hypertension, diabetes, caucasians and aged <55 y/o according to NICE guidelines, which of the following medications should be added?
1 - amlodipine
2 - spirolactone
3 - bisoprolol
4 - doxazosin
1 - amlodipine
CCB are 2nd lineL:
- Amlodipine, Diltiazem, Verapamil
Which of the following medications is is 1st line in patients with hypertension, NO diabetes, aged >55 y/o and are black African or African Caribbean according to NICE guidelines?
1 - ramipril
2 - spirolactone
3 - bisoprolol
4 - amlodipine
4 - amlodipine
Typically 1st option for CCB
Calcium channel blockers are 1st line:
Amlodipine, Diltiazem, Verapamil
If an CCB fails to control a patient with hypertension, no diabetes, black African or African Caribbean or aged <55 y/o, according to NICE guidelines, which 2 of the following medications could be added?
1 - Indapamide
2 - spirolactone
3 - bisoprolol
4 - doxazosin
5 - ramipril or candesartan
1 - Indapamide
5 - ramipril or candesartan
Second line are thiazide like diuretics OR ACE or ARB
If the 1st 2 stages fail for any patients with hypertension, what should be the 3rd group of drugs that are added?
1 - CCB
2 - ACE
3 - ARB
4 - thiazide like diuretic
5 - any of the above they are NOT already on
5 - any of the above they are NOT already on
- CCB = Amolodapine, Verapamil, Diltiazem
- ACE = Ramipril, Lisinopril, Enalapril
- ARB = Candesartan, Losartan
- thiazide like diuretic = Indapamide
If stages 1-3 have failed to control a patients BP in hypertension they should be offered either of the following:
- alpha blocker
- beta blocker
- mineralcorticoid potassium sparing
The level of K+ determines the drug used, what is the cut off used according to NICE?
1 - 1.5
2 - 2.5
3 - 4.5
4 - 6.5
3 - 4.5
- ≤4.5 mmol/l = spirolactone
- > 4.5 mmol/l = alpha or beta-blocker
If 4 drugs are unable to manage hypertension, expert advise should be requested
What is the BP target in patients aged <80 y/o?
1 - 120/90
2 - 135/90
3 - 140/90
4 - 150/90
3 - 140/90
In >80y/o BP target is <150/90
