HTN

Question 1

How does NICE define HTN?

Answer 1

• Clinic reading persistently >=140/90 mmHg
• 24 hr BP average >=135/85 mmHg

Question 2

According to NICE guidance how do you investigate and diagnose HTN in primary care?

Answer 2

1. Measure BP in both arms
2. If >140/90 repeat
3. Use the lower of both readings
4. If >=140/90 offer ABPM/HPBM
5. Diagnose HTN if average >=135/85

Question 3

Diagnosing HTN:
1. What do you do if someones BP varies between arms?
2. What is a pathological cause of this?

Answer 3

1. If difference >20, repeat. If remains >20, subsequent BP should be recorded from arm with the higher reading
2. Supravalvular aortic stenosis

Question 4

What is accelerated HTN/hypertensive emergency?

Answer 4

Severe HTN (often >220/120) with signs of end organ damage

Question 5

What clinic and ABPM/HBPM readings indicate
1. Stage 1 HTN
2. Stage 2 HTN
3. Severe HTN

Answer 5

1. > = 140/90 and subsequent average >= 135/85
2. > = 160/100 and subsequent average >= 150/95
3. Clinic systolic >= 180 or diastolic >= 120

Question 6

What do you do if someones BP in clinic >=180/120?

Answer 6

• If signs of retinal haemorrhage/papilloedema -> admit
• If new onset confusion, chest pain, signs of HF, AKI -> admit
• If none of the above -> arrange urgent investigation for end-organ damage

Question 7

How do you check for end organ damage?

Answer 7

• Fundoscopy - hypertensive retinopathy
• Urine dip - renal disease
• ECG - LV hypertrophy/IHD

Question 8

What are signs/symptoms of hypertension?

Answer 8

• Headaches
• Visual disturbances
• Seizures

Question 9

What is the management of ABPM/HBPM >=135/85?

Answer 9

Offer drug treatment if <80 AND any of…
- Target organ damage
- Establish CVD
- Renal disease
- DM
- QRISK >10%

Question 10

What is the management of ABPM/HPBM >=150/95?

Answer 10

Offer drug treatment regardless of age

Question 11

What is the management of HTN in patients <55 or with a background of T2DM? Give the 1st, 2nd and 3rd line treatment options.

Answer 11

1. ACE-In/ARB
2. Add CCB
3. Add thiazide-like diuretic

Question 12

What is the management of HTN in patients >=55 or of black African or African-Caribbean origin? Give the 1st, 2nd and 3rd line treatment options.

Answer 12

1. CCB
2. Add ACE-In/ARB (ARB if black African or African-Carribean)
3. Add thiazide-like diuretic

Question 13

What are the 4th line treatment options for HTN?

Answer 13

• If K+ <4.5mmol/l add spironolactone
• If K+ >4.5mmol/l add alpha/beta blocker

Question 14

What thiazide-like diuretic is NOT used to treat HTN?

Answer 14

Bendroflumethiazide

Question 15

Side effects of ACE inhibitors?

Answer 15

• Dry cough
• Angioedema
• Hyperkalemia

Question 16

Side effects of ARBs?

Answer 16

• Dizziness
• Hyperkalemia

Question 17

Side effects of CCBs?

Answer 17

• Dizziness
• Swollen ankles
• Constipation
• Facial flushing

Question 18

Side effects of thiazide diuretics?

Answer 18

• Dehydration
• Hyponatraemia
• Hypokalaemia

Question 19

Side effects of beta blockers?

Answer 19

• Cool hands and feet
• Poor sleep
• Impotence

Question 20

What should you tell patients with HTN worried about their medication causing impotence?

Answer 20

High BP is a RF for impotence as it leads to narrowing of arteries which reduces blood flow to the penis

Question 21

What age is used to guide HTN management?

Answer 21

55

Question 22

What are clinic BP targets if…
1. Age <80
2. Age >80

Answer 22

1. 140/90
2. 150/90