HTN, CKD, HLD

Question 1

Cardiac complications of HTN

Answer 1

CAD
Stroke
MI
vascular / haemorrhagic stroke
vascsular dementia

Question 2

When to suspect HTN

Answer 2

clinic BP reading of 140 / 90 or above

Question 3

target organ damage

Answer 3

retinopathies
stroke / MI / atherosclerosis / HF / Chronic HD
renal failure (proteinuria)

Question 4

Causes of secondary HTN

Answer 4

CHAPS
Cushing’s (cortisol ^ > + RAAS - vasodilatory system)
Hyperaldosteronism (^ aldosterone > ^ K+ OUT ^ Na+ IN ^ water retention)
Aortic coarctation (^ myocyte contraction of LV to force blood through aortic narrowing)
Pheochromocytoma (rare aldrenal gland non-cancerous tumor)
Stenosis of renal artery (v GFR > ^ BP to reperfuse kidneys)

+(Pregnancy, COCP, RICP, trauma, white coat syndrome)

Question 5

Staging cut offs

Answer 5

Pre HTN = 120/80 - 139/89
Stage 1 = 140/90 - 159/99
Stage 2 = 160/100 and above
(Stage 3 = 180/120 and above)

Question 6

HTN + T2DM treatment first line

Answer 6

ACEi / ARB

Question 7

HTN w/o T2DM + Black African etc. treatment first line

Answer 7

CCB

Question 8

HTN w/o T2DM + > 55 y/o treatment first line

Answer 8

CCB

Question 9

HTN w/o T2DM, not Black African + < 55 y/o treatment first line

Answer 9

ACEi / ARB

Question 10

HTN + T2DM treatment second line

Answer 10

ACEi / ARB
+
CCB / thiazide - like

Question 11

HTN w/o T2DM + Black African etc. treatment second line

Answer 11

CCB
+
ACEi / ARB / thiazide - like

Question 12

HTN w/o T2DM + > 55 y/o treatment second line

Answer 12

CCB
+
ACEi / ARB / thiazide - like

Question 13

HTN w/o T2DM, not Black African + < 55 y/o treatment second line

Answer 13

ACEi / ARB
+
CCB / thiazide - like

Question 14

HTN treatment third line

Answer 14

ACEi / ARB 
\+ 
CCB
\+
thiazide - like

Question 15

HTN treatment fourth line

Answer 15

• ABPM / HBPM
• consider low dose spironolactone (if K+ < 4.5)
• a X / b X (if K+ > 4.5)
• seek expert advice

Question 16

HTN in DM treatment principles

Answer 16

lifestyle mod

• T1DM first line = RAAS mod
• T2DM first line = AACEi / ARB

Question 17

HTN in renal disease treatment principles

Answer 17

if kidney function v = lifestyle mod (ACEi / ARB can be nephrotoxic)
if kidney function - = ACEi / ARB

Question 18

HTN in pregnancy treatment principles

Answer 18

lifestyle mod
+ specialist referral
+ trial alternative drugs eg. labetalol
+ monitor for pre-eclampsia (urine dip + BP + Sx)
+ arrange for secondary emergency care if pre-eclampsia is suspected

Question 19

CKD on examination

Answer 19

cognitive impairment
HTN / dehydration
hepatomegaly + bladder distention + BL flank masses
peripheral oedema
‘beer’-like urine
malnutrition
NB. not seen until substantial disease progress

Question 20

CKD RFs

Answer 20

intrinsic kidney damage - HTN, DM, glomerulonephritis
Nephrotoxic drugs - ACEi, ARBs, bisphosphonates, NSAIDs, ciclosporin
obstructive uropathies
CVD

Question 21

CKD first line investigations

Answer 21

BTing - ACR, eGFR, U&Es, HbA1c, lipids
EMUS - ACR
urine dip - haematuria / sediment abnormalities
eg. RBC = glomerular disease, WBC = pylenonephritis, Granular casts / renal tubular cells = parenchymal disease
Renal USS - stones, obstruction, PCKD

Question 22

CKD Management

Answer 22

treat underlying cause
monitor disease progression
modify lifestyle 
manage psychological impact 
CVD risk management

Question 23

Types of hyperlipidaemia

Answer 23

primary - hereditary 
    TC can be 7-20 mm/L
    statins may not cause much change 
secondary
    can treat more aggressively

Question 24

HLD Management

Answer 24

Primary prevention - atorvastatin 20 mg (if CVD risk and QRISK 10%)
Secondary prevention - atorvastatin 80 mg

Question 25

HTN stage 1

Answer 25

Clinic BP 140/90 or higher

Avg. ABPM 135/85 or higher

Question 26

HTN stage 2

Answer 26

Clinic BP 160/100 or higher

Avg. ABPM 150/95

Question 27

Sev HTN

Answer 27

clinic systolic BP 180 or higher

clinic diastolic BP 110 or higher

Question 28

lisinopril class of medication and SEs

Answer 28

ACEi

- dry cough, dizziness, headaches