Hypertension 1&2

Question 1

What is essential hypertension?

Answer 1

rise in blood pressure of unknown cause that increases risk for cerebral, cardiac and renal events

Question 2

What should be done if clinic BP is 140/90mmHg or more?

Answer 2

offer ABPM to confirm diagnosis
when using the following to confirm diagnosis ensure at least two measurements per hour during the persons usual waking hours (usually 14/day)

Question 3

What are the guidelines for HBPM?

Answer 3

• Two consecutive seated measurements, 1 minute apart
• BP is recorded twice a day for at least 4 days and preferably for 7 days
• measurements on the first day are discarded- average value of all remaining is used

Question 4

Define stage 1 hypertension

Answer 4

Clinic BP is 140/90 mmHg or higher and

ABPM or HBPM daytime average is 135/85 mmHg or higher

Question 5

Define stage 2 hypertension

Answer 5

Clinic BP 160/100 mmHg or higher and

ABPM or HBPM daytime average is 150/95 mmHg
or higher.

Question 6

Define severe hypertension

Answer 6

Clinic BP is 180 mmHg or higher or

Clinic diastolic BP is 110 mmHg or higher.

Question 7

What tests should be arranged for all hypertensives?

Answer 7

> test urine for protein
take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and glucose
examine fungi for hypertensive retinopathy
arrange a 12 lead ECG

Question 8

What is the main driver of absolute risk

Answer 8

Age

Question 9

What are the established vascular diseases?

Answer 9

Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease
Diabetes

Question 10

What are the guidelines for clinic BP in patients with treated hypertension?

Answer 10

o 140/90mmHg in people under 80

o 150/90mmHg in people aged 80 and over

Question 11

What are the guidelines for ABPM/HBPM BP in patients with treated hypertension?

Answer 11

o below 135/85mmHg in people under 80

o below 145/85mmHg in people over 80

Question 12

What are some common causes of secondary hypertension?

Answer 12

> renal disease
obstructive sleep apneoa
aldostenoism
reno-vascular disease

Question 13

What are some rare causes of secondary hypertension?

Answer 13

> Cushings
Pheochromocytoma
Aortic coarctation
Intracranial tumour

Question 14

What lifestyle advice should be offered?

Answer 14

• Diet (reduce sodium and caffeine)
• weight reduction
• exercise
• alcohol
• smoking

Question 15

What reduction in systolic BP can be seen per Kg of weight?

Answer 15

1mmHg

Question 16

Which drugs can be prescribed for hypertension?

Answer 16

• thiazide diuretics
• ACE inhibitors/ARBs
• CCBs
• beta blockers
• spironolactone, alpha blockers

Question 17

What is the targeted treatment for angina?

Answer 17

b blockers (Ca blockers)

Question 18

What are the targeted therapies for congestive cardiac failure?

Answer 18

ACEI and B blockers

Question 19

What are the targeted therapies in diabetic nephropathy?

Answer 19

ACEI and ARBs

Question 20

What is the targeted therapy for prostatism?

Answer 20

Alpha blockers

Question 21

What are the causes for resistant hypertension?

Answer 21

>non-concordance
>white coat effect
>pseudo-hypertension
>lifestyle factors
>drug interactions
>secondary hypertension
>true resistance

Question 22

What is the saying for prescribing spironolactone?

Answer 22

Start low, go slow

Question 23

When should spironolactone be prescribed with caution?

Answer 23

diabetes & low GFR

Question 24

What is the dosage for spironolactone prescription?

Answer 24

12.5mg/day (25mg every second day)