HTN

Question 1

HTN diagnosis, grades

Answer 1

> = 140/90
two sittings* within 3 months

Grade 1 - Mild >=140/90
Grade 2 - Mod >=160/100
Grade 3 - Sev >=180/110

Isolated systolic - >=140/<90

Question 2

Frequency of BP check in >18yrs, mod risk, high risk pts

Answer 2

*>18yrs - 2yrly
mod risk - 6-12months
sev risk - 6-12wks

Question 3

Causes of HTN

Answer 3

1. Essential HTN (90-95% cases - no cause)
2. Kidney - *RAS, glomerulonephritis
3. Endocrine - Conns, cushings, pheochromocytoma
4. OCP, Steroids
5. PAN
6. Coarctation of aorta

Question 4

Malignant HTN

Answer 4

1. Diastolic BP >120
2. Exudates in retina, kidney

Question 5

Refractory HTN

Answer 5

BP > 140/90
Despite max dose of 2 drugs
for 3-4 months

Question 6

RAS causes, inv, Mx

Answer 6

Renal artery stenosis
1. Atherosclerosis - elderly
2. Fibromuscular dysplasia - young

Inv - Doppler USG

Mx - ACEI/ARB

Question 7

Mx of pt with <120/80 BP

Answer 7

Recheck in 2 yrs

Question 8

Mx of High normal BP pt

Answer 8

120-139/80-89
Recheck in 1yr
Life style advice

Question 9

Mx of Grade 1 HTN pt

Answer 9

140-159/90-99
Recheck in 2 months
Life style advice

Question 10

Mx of Grade 2 HTN pt

Answer 10

160-179/100-109
Recheck in 1 month
Life style advice

Question 11

Mx of Grade 3 HTN

Answer 11

> 180/110
Multiple readings same day
Can start on antiHTN

Question 12

When do you prescribe drugs for HTN

Answer 12

Grade 3 HTN, organ damage

Question 13

Ambulatory 24-hour monitoring

Answer 13

1. Marked discrepancy b/w two readings (office vs office or office vs home)
2. Borderline/refractory HTN (eliminate white coat effect)
3. Resistance to drug rx
4. Suspected sleep apnoea

Question 14

When do you suggest life style modification

Answer 14

High normal, Grade 1 and 2 pts
Grade 1, 2 - LSM for 3 months minimum

Assess cardiovascular risk (multiple checks-high BP)
●Low risk: 6-12months LSM … drugs
●Mod risk: 3-6 months LSM … drugs
●Sev risk: LSM AND RX

1. Wt reduction (1kg - 2.5/1.5 change)
2. ↓Salt
3. ↓Alcohol (2SD permitted/day)
4. Stop smoking
5. Diet, exercise

Question 15

Rx for HTN

Answer 15

●>55yrs - ACD (B)
ACEI/ARB
(or)
CCB - ↓muscle contraction =↓contraction heart,vessels (or)
Diuretics (thiazide)

●If target BP not reached in 3 months - combination therapy
1. ACEI/ARB + CCB
2. ACEI/ARB + Diuretics
3. ACEI/ARB + B blockers

●If target still not reached in next 3 months - 3 drugs
ACEI/ARB + CCB + Diuretics

●If target still not reached
Add Spironolactone

●If target still not reached
Specialist advice

Question 16

Why avoid B blockers with Verapamil

Answer 16

Verapamil - rate limiting CCB
Both together can cause heart block/HF

Question 17

Why avoid ACEI/ARB with spironolactone

Answer 17

↑K

Question 18

AntiHTN used in pregnancy

Answer 18

Methyldopa (or)
CCB

Question 19

Avoid B blockers in

Answer 19

1. Asthma
2. Bradycardia
3. Heart block
4. Peripheral vascular disease (best CCB)

Question 20

Avoid rate limiting CCB in

Answer 20

1. Heart block
2. Bradycardia
3. Bowel disease

Careful:
1. Cardiac failure
2. RAS

Question 21

Avoid diuretics in

Answer 21

1. DM (best ACEI/ARB)
2. Hyperlipidemia
3. Gout/hyperuricaemia (best ACEI/ARB)
4. Pregnancy
5. Impotence
6. Bowel disease

Question 22

U/l vs b/l RAS rx

Answer 22

U/l - ACEI
B/l - CCB