HTN

Question 1

What are the clinical stages of HTN?

Answer 1

  Stage 1: Clinic BP > 140/90 
  Stage 2: Clinic BP > 160/100 
  Severe: Clinic BP > 180/110 
  Malignant: BP > 180/110 + papilloedema and/or retinal 
haemorrhage 
  Isolated SHT: SBP ≥140, DBP <90

Question 2

Name three causes of HTN

Answer 2

Primary- 95%
Renal: RAS, GN
Endo
Drugs
Pregnancy
Fluid overload

Question 3

State three endocrine causes of HTN

Answer 3

hyperthyroidism, cushing’s, phaeo, conn’s

Question 4

Name two drugs that cause HTN

Answer 4

cocaine, NSAIDs, oral contraceptive pill

Question 5

What are the complications of HTN?

Answer 5

End organ failure- CANER

Cardiac
 IHD
 LVH → CCF
 AR, MR

Aortic
 Aneurysm
 Dissection

Neuro
 CVA: ischaemic, haemorrhagic
 Encephalopathy (malignant HTN)

Eyes: hypertensive retinopathy
e.g. papilloedema

Renal
 Proteinuria
 CRF

Question 6

Investigations for HTN?

Answer 6

24 hr ABPM
Urine: haematuria, alb:cr ratio
Bloods: FBC, U+Es, LFTs, glucose, fasting lipids
ECG

Question 7

What are the indications for commencing pharmacological treatment for HTN?

Answer 7

1. <80yrs, stage 1 HTN (>140/90) and one of:
   - Target organ damage,
   - DM
   - Renal disease
   - Established CVD
2. Anyone with stage 2 HTN (>160/100)
3. Malignant HTN

Question 8

What is the antihypertensive choice for <55/caucasian?

Answer 8

ACEi/ARB

Question 9

Antihypertensive for >55/black?

Answer 9

CCB

Question 10

53 y/o caucasian man is on lisonopril and nifedipine. His BP is still suboptimal. What can be done now?

Answer 10

add thiazide-like diuretic

Question 11

Describe the pathophysiology of HTN

Answer 11

1. Overactive RAS
2. Increased sympathetic stimulation
3. Growth factor stimulation e.g. endothelin and angiotensin, triggering vascular remodelling

Question 12

What are the non-modifiable risk factors for primary hypertension?

Answer 12

age, gender, ethnicity, genetic factors

Question 13

What are the modifiable risk factors for secondary hypertension?

Answer 13

diet, physical activity, obesity, alcohol in excess, stress

Question 14

Which BP measuring procedures should be carried out?

Answer 14

BP both arms >2 readings on two or more occasions, ambulatory BP monitoring

Question 15

In untreated hypertension, what are examples of end-organ damage?

Answer 15

retinopathy, congestive HF, aortic aneurysm, left ventric hypertrophy, neurological deficit

Question 16

What are the classes of antihypertensive drugs?

Answer 16

diuretics, ACEi/ARBs, vasodilators (CCB, BB, alpha blockers)

Question 17

Someone with diabetes requires antihypertensive therapy, which drug would be most helpful to them?

Answer 17

ACEi

Question 18

List four secondary causes of hypertension

Answer 18

pregnancy, endocrine e.g. hyperaldosteronism, obesity, renal disease. ROPE- renal, obesity, pregnancy, endocrine

Question 19

Which cardiac drug is associated with angiodema?

Answer 19

ACEi e.g. ramipril

Question 20

What are the guidelines for adding on antiHTN agents?

Answer 20

ACEi

Add CCB or thiazide-like diuretic