HT

Question 1

How diagnose ht?

Answer 1

• Elevated bp on 3 occasions at least 2 days apart
• if bp severely elevated, 3 readings at first visit and ensure cuff is right.
Systolic ≥ 140
Diastolic ≥ 90

Question 2

Define mild ht

Answer 2

Systolic 140-159

Diastolic 90-99

Question 3

Define moderate ht

Answer 3

Systolic 160-179

Diastolic 100-109

Question 4

Define severe bp

Answer 4

Systolic ≥ 180

Diastolic ≥ 110

Question 5

Baseline testing for ht? (4)

Answer 5

• urine protein by dipstick. If positive, send blood for creatinine and eGFR
• BMI for cv risk assessment
• abdominal circumference
• serum potassium concentration if on ace-i or eGFR <30

Question 6

Six monthly monitoring for ht?

Answer 6

Serum potassium concentration if on spironolactone (K sparing diuretic) or eGFR <30

Question 7

Annual monitoring for ht? (3)

Answer 7

• Fingerprick blood glucose
• Urine protein
• serum creatinine and eGFR in patients who have proteinuria, existing cv disease, ht for 10 years or more or uncontrolled, CKD eGFR < 60

Question 8

Treatment for mild ht?

Answer 8

• If no cv risk factors, initiate lifestyle modification. If poor compliance after 3 months, initiate medicine
• if risk factors, medicine and lifestyle

Question 9

Treatment for moderate ht?

Answer 9

• confirm diagnosis within 2 weeks

* initial treatment after confirm diagnosis- lifestyle and hydrochlorothiazide

Question 10

Treatment for severe HT?

Answer 10

Confirm diagnosis within 1 hour
Initiate third line treatment if. not symptomatic- lifestyle, hctz, CCB or ace-i
If symptoms , hypertensive urgency/emergency
Follow up in 1 week
Refer if bp > 160/100 after 4 weeks

Question 11

First line treatment ht?

Answer 11

Lifestyle modification.

Question 12

Second line treatment ht?

Answer 12

Lifestyle
And

Ace-i eg enalapril 10 mg

Question 13

Third line treatment ht?

Answer 13

Lifestyle and Ace-i eg enalapril 10 mg

Hctz 12,5 mg, or
Long acting CCB eg amlodipine 5mg or

Question 14

Fourth line treatment ht?

Answer 14

• Lifestyle and
• Hctz 12,5 mg and
• increase dose of drug added in third line eg increase amlodipine from 5 to 10 mg or enalapril from 10 to 20 mg

Question 15

Fifth line treatment ht?

Answer 15

• Lifestyle and
• hctz 12,5 mg and
• ace-i 10 mg if not started in 4th line, otherwise continue 20 mg
• amlodipine (CcB) continue 10 mg from step four, otherwise start 5 mg

Question 16

Sixth line treatment ht?

Answer 16

• Lifestyle and
• hctz 12,5 mg
• ace-i eg enalapril 20 mg
. CCB eg amlodipine 10 mg

Question 17

Seventh line treatment ht?

Answer 17

• Lifestyle and
• hctz 12,5 mg
• ace-i eg enalapril 20 mg
. CCB eg amlodipine 10 mg and
• spironolactone 25 mg
If still not controlled refer

Question 18

Contraindication spironolactone and why?

Answer 18

Kidney failure eGFR <30
Pregnancy
Can cause severe hyperkalaemia and should only be used when serum potassium can be monitored, do not use with potassium supplements

Question 19

Name 4 contraindications to hydrochlorothiazide

Answer 19

• Gout
• pregnancy
• severe liver impairment
. Kidney impairment eGFR <30

Question 20

Name 6 contraindications to ace-i

Answer 20

• Pregnancy
. Bilateral renal artery stenosis or stenosis of an artery to a dominant or single kidney
• aortic valve stenosis
• history angioedema
• hyperkalemia
• severe renal impair egfr <30

Question 21

Common symptom of ace-i?

Answer 21

Angioedema

Question 22

Contraindication to calcium channel blockers?

Answer 22

Untreated heart failure

Question 23

Treatment of hypertensive emergency?

Answer 23

Amlodipine 10 mg stat oral
If pulmonary oedema, furosemide iv 40 mg as single dose
Refer immediately

Question 24

Name 7 cardiovascular risk factors

Answer 24

• Hypertension
• family history premature cv disease (men < 55 years, women <65)
• history Tobacco smoking
• evidence overweight/obesity (BMI or waist circumference >102 cm in men and > 88 cm women)
• Dyslipidaemia (xanthoma, total cholesterol > 6,5 or LDL >4 or HDL <1 men <1, 4 women)
• Dm,
• Ages > 55 men > 65 women

Question 25

Drugs of choice for angina and ht?

Answer 25

Beta blocker or CCB

Question 26

Drugs of choice for Prior mi and ht?

Answer 26

Beta blocker and ace-i (ARB if tolerant)

Verapamil if beta blockers contraindicated

Question 27

Define refractory hypertension

Answer 27

Not optimally controlled on 3 or more classes antihypertensives
Must exclude secondary causes and refer.

Question 28

Which antihypentensive is renal protective?

Answer 28

Ace-i eg enalapril

Question 29

Name complications /symptoms associated with hypertensive emergency (6)

Answer 29

• Ht encephalopathy (severe headache, visual disturbance,confusion, seizures,coma)
• unstable angina /mi
• acute lv failure, pulmonary oedema
• eclampsia, severe pre-eclampsia
• acute aortic dissection
• AKI