HTN

Question 1

Definition of HTN: clinic vs home/ambulatory

Answer 1

140/90 vs 135/85

Question 2

Essential HTN accounts for what % of HTN

Answer 2

95%

Question 3

Secondary causes of HTN

Answer 3

ROPE
R- renal dx (if v high consider renal artery stenosis)
O- obesity
P- pregnancy induced hypertension/pre-eclampsia
E- endocrine eg hyperaldosteronism (Conns)

Question 4

Stage 1 HTN

Answer 4

Clinic > 140/90

Ambulatory >135/85

Question 5

Stage 2 HTN

Answer 5

Clinic >160/100

Ambulatory > 150/95

Question 6

Stage 3 HTN

Answer 6

> 180/120

Question 7

Additional investigations for patients w new diagnosis of HTN

Answer 7

Urine albumin:creatinine ratio for proteinuria and dipstick for haematuria for kidney damage
Bloods for HbA1c, renal function and lipids
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities

Question 8

Treatment targets for <80 years

Answer 8

<140 systolic

<90 diastolic

Question 9

Treatment targets for >80 years

Answer 9

<150

<90

Question 10

Symptoms and signs

Answer 10

Usually asymptomatic until v high
Headache
Visual disturbance
Seizure

Question 11

When do you offer ABPM/HBPM

Answer 11

Any pt w BP >140/90

Question 12

What is ambulatory blood pressure monitoring (ABPM)

Answer 12

> 2 measurements/hr during pt normal waking hours

Use average value of at least 14 measurements

Question 13

What is home blood pressure monitoring (HBPM)

Answer 13

Seated BP
2 consecutive measurements at least one min apart
Record twice daily
At least 4 days
Ignore 1st day and take average of all other readings

Question 14

Lifestyle advice HTN

Answer 14

Low salt <6g a day
Dec caffeine
Stop smoking, drink less alcohol, eat more fruit and veg etc etc

Question 15

Step 1 medical treatments of HTN

Answer 15

<55 or a BG of DM–> ACEi or ARB

>55 or black–> Ca channel blocker

Question 16

Step 2 medical treatments of HTN

Answer 16

Add a Ca channel blocker or Thiazide-like Diuretic

If already taking C, take an ACEi or ARB (if black use ARB preferably)

(A + C) or (A + D) or (C + A) or (C + D)

Question 17

Step 3 medical treatments of HTN

Answer 17

Add a third drug to make A + C +D

Question 18

Step 4 treatment HTN (resistant)

Answer 18

If K<4.5 add low dose spironolactone
If K> 4.5 add an alpha (doxazosin) or beta blocker (atenolol)

Need to also confirm elevated clinic BP w ABPM or HBPM
Assess postural hypotension
Discuss adherence

Question 19

What type of diuretic is spironolactone

Answer 19

K sparing

Question 20

What type of diuretic is indapamide

Answer 20

Thiazide-like

Question 21

What is malignant HTN

Answer 21

Rapid rise in BP–> vascular damage
Hallmark is fibrinoid necrosis
Bilateral retinal haemorrhages and exudates
Papilloedema