HTN

Question 1

in what patient populations is hypertension more common in?

Answer 1

advancing age,
women aged 65-74,
people of African origin

Question 2

what are the complications of hypertension?

Answer 2

stroke, MI, heart failure, renal failure and dissecting aortic aneurysm

Question 3

what sounds are you listening for when using a stethoscope to measure bp manually?

Answer 3

korotkoff

Question 4

how many distinct korotkoff sound phases are there?

Answer 4

5

Question 5

what produces korotkoff sounds?

Answer 5

blood pressure cuff changes the flow of blood through the artery

Question 6

what should phase 1 korotkoff sound like?

Answer 6

1st sound heard
sharp tapping as cuff pressure released and provides systolic pressure reading

Question 7

what should phase 2 korotkoff sound like?

Answer 7

swishing sound as blood flows through vessels as cuff is deflated

Question 8

what does phase 3 korotkoff sound like?

Answer 8

thump sounds softer than phase 1 as blood flows through artery but cuff pressure inflated to occlude flow inside diastole

Question 9

what does phase 4 korotkoff sound like?

Answer 9

soft muffled sound as cuff pressure released

Question 10

what does phase 5 korotkoff sound like?

Answer 10

silence as cuff pressure released enough to allow normal blood flow

Question 11

the point at which all sounds completely disappear is the X pressure?

Answer 11

diastolic

Question 12

what is defined as stage 1 hypertension?

Answer 12

clinic reading 140/90 -160/100

Question 13

stage 1 htn is a ambulatory daytime average of home bp monitoring of?

Answer 13

average 135/85 or higher

Question 14

what is defined as stage 2 hypertension?

Answer 14

clinic BP 160/100 - 180/120

Question 15

stage 2 htn is an ambulatory daytime average of home blood pressure average of ?

Answer 15

150/95 or higher

Question 16

what does htn Tx aim to do?

Answer 16

reduce the risk of cardiovascular morbidity and mortality, by reducing BP

Question 17

what algorithm is used to calculate an accurate assessment of cv risk as a guide to htn management and level of risk for patient and if and when pharmacological treatment is needed?

Answer 17

QRISK3

Question 18

what does QRISK3 indicate?

Answer 18

persons risk of developing heart attack or stroke over next 10 years

Question 19

true or false, QRISK3 prevents average risk of people with same risk factors as those entered for that person?

Answer 19

true

Question 20

it is important that before adding an additional agent to control htn you ave tried the first agent to the maximal dose. What might prevent you from doing this?

Answer 20

SEs

Question 21

What is the target clinic blood pressure for a 50 year old male with no other co-morbidities?

Answer 21

below 140/90

Question 22

Why do blood pressure targets vary?

Answer 22

location
anxiety
stress
px characteristics

Question 23

Why are ACE or ARBs not first line in people who are African or African-Caribbean family origin?

Answer 23

lower renin levels hence less of a response to drugs that act via RAS

Question 24

Why is it specifically thiazide-like diuretics that are recommended for HTN and not loop diuretics like furosemide?

Answer 24

thiazide like act on dct where less filtered sodium reabs
loop act on ascending loh where more sodium reabs
more efficient water loss but short half life so not good for consistent sustained bp drop

Question 25

what should be the next step if clinic bp is high?

Answer 25

offer ABPM/ HBPM

Question 26

why should you palpate the radial/brachial pulse before measuring BP?

Answer 26

to see if there any irregularities in the heartbeat

Question 27

What to do if you get irregularities in the heartbeat or bp readings

Answer 27

repeat the bp reading

Question 28

what should you do if someone has postural dizziness?

Answer 28

measure bp sitting and standing

Question 29

how long should you wait between bp readings?

Answer 29

at least 1 min

Question 30

what could be a reason that someone under 40 has hypertension?

Answer 30

CKD
diabetic neuropathy
renal cell carcinoma
primary hyperaldosteronism

Question 31

what should be investigated if someone is newly diagnosed with hypertension

Answer 31

organ damage (eye, kidney)

Question 32

what tests are used to assess organ damage?

Answer 32

measure:
UACR (check protein in urine)
hbA1c (for diabetes)
elec, creat, eGFR (CKD assessment)

Question 33

what things need to be investigated if someone has been diagnosed with hypertension?

Answer 33

CV risk - cholesterol, QRISK
assess organ damage
consider need for investigation if secondary htn suspected

Question 34

when should you refer someone to a specialist same day service?

Answer 34

if clinic bp over 180/120 and signs of retinal haemorrhage or AKI and signs of hypertension

Question 35

lifestyle advice for people with hypertension

Answer 35

healthy diet and regular exercise
reduce caffeine
reduce dietary sodium
smoking and alcohol

Question 36

what antihypertensives are safe in pregnancy? 3

Answer 36

labetalol, methyldopa, nifedipine

Question 37

why is the target bp higher for the elderly?

Answer 37

risk of oevrtreating and falls

Question 38

why is the target BP lower for someone with diabetes

Answer 38

increased CV risk

Question 39

when is ACEi/ ARB 1st line?

Answer 39

HTN w T2DM
OR
age<55 and non black african/ afro caribbean

Question 40

when is CCB 1st line?

Answer 40

no T2DM but over 55 OR black african/ afro carribean