HTN

Question 1

Clinical signs of HTN

Answer 1

Haematuria
Papilloedema and visual problems
Headaches
Nosebleeds

Question 2

Common causes of HTN

Answer 2

Primary - idiopathic 95%
Renal artery stenosis 
Endocrine - Cushing’s disease/ Conn’s disease/ Phaeochromocytoma/Acromegaly 
Hyperthyroidism 
Adult polycystic kidney disorder

Question 3

Investigations

Answer 3

Observations 
BP - 24 hr ambulatory 
Bloods - FBC, U+Es, LFTs, TFTs
Urine dipstick - haematuria and Alb: Cr 
ECG
Qrisk

Question 4

Non pharmological advice

Answer 4

Decrease salt and cholesterol intake 
Lose weight to health weight 
Exercise more 
Reduce alcohol and caffeine consumption 
Smoking cessation

Question 5

HTN stages

Answer 5

Stage 1 - 140/90 
Stage 2 - 160/100
Stage 3 - 180/120
Malignant: BP > 180/120 + papilloedema and/or retinal
haemorrhage

Ambulatory :
Stage 1 - 135/85
Stage 2 - 150/95

Question 6

HTN stepwise management

Answer 6

Stage 1

• if Afro Caribbean or 55+ yo - CCB
• if not, ACEi/ ARB

Stage 2
- ACEi + CCB

Stage 3
- ACEi+ CCB + thiazide like diuretic

Stage 4:
Add on
- beta blocker
- spironolactone - if plasma K+ < 4.5

Question 7

Complications of untreated HTN

Answer 7

HF - increased afterload causes LV hypertrophy
IHD and MI - due to arterial damage and increased risk of arteriosclerosis
Retinopathy
CKD
Stroke
Aneurysm

Question 8

Hypertensive retinopathy sign

Answer 8

Flame haemorrhages + cotton wool spots

Question 9

BP goal if over 80

Answer 9

<150/90

Question 10

Contraindications for ACEi

Answer 10

Pregnancy
Impaired renal function
Afro Carribean

Question 11

Side effects of ACEi

Answer 11

Dry cough
Angioedema
Hyperkalaemia

Question 12

Side effects of CCBs

Answer 12

Flushing
Ankle swelling
Headache

Question 13

If 180/120

Answer 13

Admit for special assessment if:

• signs of retinal haemorrhage or papilloedema
• new onset confusion, chest pain, HF or AKI

If not:

• urgent investigations for end organ damage
• if no organ damage - repeat measurement in 7 days