Hypertension 1

Question 1

What is hypertension?

Answer 1

BP value of 140/90mmHg.

Question 2

What are the 3 stages of hypertension? When would an ABPM be recommended?

Answer 2

Stage 1- at or above 140/90. After 140/90 finding at clinic, ABPM must be used to Confirm Diagnosis (NICE)

Stage 2- at or above 160/100

Severe- at or above 180/110- Dont wait for ABPM, start ACE/Ca immeadiately.

Question 3

What is the “white coat” effect?

Answer 3

The generation of different values of BP of the same patient when measured by different professionals.

Question 4

What tests should you carry out in a hypertensive patient? (4)

Answer 4

1. -test urine for protein in urine
2. FBC- check glucose, electrolytes, creatinine, cholesterol, estimated glomerular filtration rate.
3. examine fundi (base) of eye for hypertensive retinopathy
4. arrange a 12 lead ECG.

Question 5

What is the most important Absolute risk of hypertension?

Answer 5

Age

Question 6

What are some other physiological risk factors that can cause end organ damage?

Answer 6

• LVH -Retinopathy - Raised creatinine - albuminuria/micro-albuminuria.

Question 7

What are some common types of vascular disease?

Answer 7

1. Ischaemic 2. Cerebro- vascular 3. Peripheral 4. Diabetes

Question 8

What things should be part of the medical assessment?

Answer 8

• Medical history - FH of premature CVD - Blood pressure readings - Cardiovascular examination - Smoking - Examine fundi

Question 9

What are the grades of hypertensive retinopathy?

Answer 9

Grade 1- slight narrowing of retinal arterioles Grade 2- severe narrowing of retinal arterioles Grade 3- bilateral soft exudates or flame shaped haemorrhages. Grade 4- bilateral optic nerve oedema.

Question 10

What are some factors that can cause hypertension?

Answer 10

Genetics, environment, diet, age, exercise, smoking, race, gender, other conditions,

Question 11

What are some causes of secondary hypertension?

Answer 11

1. Common: - Renal disease - Reno-vascular disease -Aldosteronism - obstructive sleep apnoea 2. Uncommon - Cushings -Conns - Pheochromocytoma: tumour of adrenal gland tissue. Uncontrolled release of adrenaline + noradrenaline causing raised HR, BP. - Hyperthyroidism - Aortic coarctatation - Intracranial tumour

Question 12

What is fibro-muscular dysplasia?

Answer 12

Non atherosclerotic, non inflammatory condition where the blood vessel has abnormal growth on the wall of the artery.