HTN

Question 1

what are the 3 types of HTN?

Answer 1

1. Isolated systolic HTN (>160/<90)
   - atherosclerosis
   - multifactorial causes
2. Malignant HTN (e.g. 200/130)
   - rapid rise in BP leads to vascular damage
   - bilateral retinal haemorrhages, headaches and visual disturbance
   - can lead to AKI, HF and encephalopathy
3. Secondary HTN
   - HTN caused by other disease

Question 2

What are the secondary causes of HTN?

Answer 2

1. renal disease - CKD, Polycystic kidneys, nephritic, renal artery stenosis
2. Endocrine -Phaeochromocytoma, Conn’s, Cushing’s, acromegaly
3. drugs e.g. COCP, recreational
4. Pregnancy - pre-eclampsia

Question 3

what is the cause of isolated HTN

Answer 3

Atherosclerosis of arteries

caused by risk factors e.g. diet, diabetes, hypercholesterolaemia/lipidaemia, smoking etc

Question 4

what is malignant HTN?

Answer 4

Very high BP - emergency
e.g. 200/130

rapid rise in BP leads to vascular damage

• bilateral retinal haemorrhages, headaches and visual disturbance
• can lead to AKI, HF and encephalopathy

Question 5

what can malignant HTN lead to?

Answer 5

Emergency

• bilateral retinal haemorrhages, headaches and visual disturbance
• can lead to AKI, HF and encephalopathy

Question 6

what are the grades of HTN

Answer 6

grade 1 = >140/90

grade 2 = >160/100

grade 3 = >180/110

isolated systolic = >160/<90

Question 7

what are the signs and symptoms of HTN

Answer 7

Mainly asymptomatic
- headaches, visual changes, nose bleeds

Signs

• ocular changes, retinopathy
• haematuria/proteinuria, renal bruit, palpable kidney
• radial/femoral delay (CoA)
• increased HR (thyroid)

Question 8

What are the investigations you could do in someone with HTN? To diagnose, to find cause and to find complication

Answer 8

Diagnose = 24hour BP monitoring

Cause:

• blood = FBC, TFT, LFT, U&E, glucose, cholesterol
• urine dip = adrenaline, cortisol, blood/protein
• check medications e.g. COCP
• USS of kidneys
• Renin : aldosterone
• Ca - hyperparathyroidism

Complications:
- U&E, fundoscopy

Question 9

How is HTN treated?

Answer 9

Conservative = smoking, exercise, salt, alcohol, weight, stress etc

<55y/o and white ethnicity =

1) ACEi (Ramipril) or ARB (losartan)
2) add Ca channel blocker (Amylodipine)
3) add thiazide diuretic (Indapamide)

> 55 or Black Ethnicity:

1) Ca channel blocker (Amylodipine)
2) add ACEi/ARB
3) add thiazide (indapamide)

After this can also add further diuretics + b blocker + alpha blocker if needed

Consider protection with statin/aspirin too

Question 10

who is treated for HTN i.e. what is the cut off?

Answer 10

anyone with BP over 160/100

Diabetes + 135/80 (also CVS risk/end organ failure)

Question 11

what are the complications of HTN?

Answer 11

CKD
retinopathy
ACS
arrhythmias 
Thrombi/emboli formation
headaches
acute/chronic limb ischaemia
aneurysms

Question 12

describe the different grades of Hypertensive retinopathy. what does each sign correspond to in terms of pathology

Answer 12

Grade 1 = silver wiring, torturous retinal arteries

Grade 2 = above + AV nipping

Grade 3 = above + lipid deposits, cotton wool spots and flame haemorrhages

Grade 4 = above + papilloedema

Question 13

what are blood pressure targets for <80yrs, >80yrs and diabetics

Answer 13

<80 = <140/90

> 80 = <150/90

diabetics = <130/80

Question 14

how is malignant HTN treated?

Answer 14

Emergency so admit and ABCDE

Give oral B blockers or CaB

If they have encephalopathy or HF:

• Furosemide
• Na nitroprusside or IV labetolol