HTN

Question 1

Summarise end-organ damage complications of hypertension? [5]

Answer 1

Brain - Haemorrhage, Stroke, Cognitive Decline
Heart - LVH, CHD, CHF, MI
Kidneys - Renal Failure 
Peripheral vascular disease
Eyes - Retinopathy

Question 2

Name 6 categories secondary hypertension?

What are 2 physiological causes of HTN?

Answer 2

Endocrine
Renal
Vascular
Sleep Apnoea
Pregnancy
Drug Induced

Aging and pregnancy are inevitable causes of HTN

Question 3

Name 4 renal diseases that can cause hypertension?

Answer 3

Chronic Infection
FIbromuscular Dysplasia
Renal Artery Stenosis
Polycystic Kidney Disease

Question 4

Name 3 drug types that can cause hypertension?

Answer 4

NSAIDs
Oral Contraceptives
Corticosteroids

Question 5

Name 6 endocrine diseases causing hypertension?

Answer 5

Conn's Syndrome
Cushing's Syndrome
Pheochromocytoma
Hypo and Hyper Thyroidism
Acromegaly
GRA

Question 6

Name a single vascular cause of hypertension?

Answer 6

Coarctation of the Aorta

Question 7

GRA is a genetic cause of hypertension. What is the problem? [2] How is it inherited?

Answer 7

Glucocorticoid Remediable Aldosteronism - autosomal Dominant inherited condition

Increases aldosterone secretion due to aldosterone synthase enzyme becoming sensitive to ACTH

Question 8

Accelerated/malignant HTN
Accelerated HTN is defined as [3]
Malignant HTN is defined as [3]

Answer 8

Accelerated HTN:
- Increase in BP to ≥180 mm Hg systolic and ≥110 mm Hg diastolic
- Resulting in target organ damage
- Plus grade 3 retinal changes
Malignant HTN:
- Increase in BP to ≥180 mm Hg systolic and ≥110 mm Hg diastolic
- Resulting in target organ damage
- Papilloedema grade 4 fundal changes present

Question 9

Hypertensive urgency is defined as [1]

Answer 9

Severe HTN with no evidence of target organ damage

Question 10

Accelerated HTN Mx
If pulmonary edema [3]
If encephalopathy [5]

Answer 10

Pulmonary edema:
1) IV GTN at low dose and up-titrate
2) IV furosemide
3) Initiate oral eg amlodipine 5mg +/- other when stable
Encephalopathy:
1) IV nicardipine
2) IV clevidipine
3) IV labetalol
4) IV esmolol
5) Initiate oral eg amlodipine 5mg +/- other when stable

Question 11

In hypertensive emergencies, what are the drugs you should NOT give [3]

Answer 11

Rapidly acting nifedipine or ACEI
Hydralazine
Sodium nitroprusside

Question 12

What do we call Hypertension in pregnancy with proteinuria?

Answer 12

Pre-Eclampsia

Question 13

How may hypertension arise in pregnancy? [3]

Answer 13

• Existing Primary Hypertension
• May rise during pregnancy, Gestational Hypertension (without proteinuria)
• May rise suddenly after 20 weeks with proteinuria (>300mg/24 hours)

Question 14

What is pre-eclampsia then?

Answer 14

Hypertension during pregnancy with proteinuria, often starting after 20 weeks

Question 15

What can you give hypertensive women pre-pregnancy? [3]

What NOT to give? [2]

Answer 15

Nifedipine modified release (basically slow release)
Methyldopa (centrally acting agent)
Atenolol or Labetalol (B blockers)

Not an ACEI or ARB

Question 16

What would you give a hypertensive woman during pregnancy? [2]

Answer 16

Add a thiazide diuretic and/or amlodipine (vasodilating CCB) to the pre-pregnancy treatment.

Question 17

What would you give someone with pre-eclampsia? [6]

Answer 17

The same pre-pregnancy treatment [1] and the thiazide diuretic [1] or amlodipine [1] adding once pregnancy started.
Specifically for pre-eclampsia patients add IV esmolol [1] labetalol [1] & hydralazine [1]

Question 18

What must you remember about Nifedipine?

Answer 18

Never use immediate release nifedipine only sustained release

Question 19

Why should we avoid ACE inhibitors in young women if possible? [2]

Answer 19

ACE inhibitors are teratogenic [1], so if the women happen to fall pregnant it can cause congenital disorders [1]