Hypertension

Question 1

WHO defines hypertension as a blood pressure greater than 120/80. True/False?

Answer 1

False
Hypertension is classically BP greater than 140/90

Question 2

How does eating salt increase blood pressure?

Answer 2

Increases release of aldosterone, which causes salt and fluid retention [part of RAAS]

Question 3

What are some common causes of secondary hypertension?

Answer 3

Renal disease/stenosis
Endocrine disease
Drug therapy

Question 4

How can renal disease lead to hypertension?

Answer 4

Reduced renal flow causes excess renin release, ultimately leading to fluid overload

Question 5

Conn’s syndrome is an endocrine cause of hypertension - what happens?

Answer 5

Excess production of aldosterone, leading to fluid overload

Question 6

What is Cushing’s syndrome?

Answer 6

Excess production of corticosteroid, usually cortisol

Question 7

What are the clinicopathological classifications of hypertension?

Answer 7

Benign
Malignant

Question 8

What is meant by benign hypertension?

Answer 8

Generally “asymptomatic” but this does not take away from the danger it poses and should be treated as aggressively as normal

Question 9

Every __ mm Hg above diastolic pressure of 85 mm Hg doubles the risk of an MI

Answer 9

10 mm Hg

Question 10

What blood vessel changes occur in hypertension?

Answer 10

Thickening of media (smooth muscle) layer
Arteriosclerosis (hardened arteries)

Question 11

Define malignant hypertension

Answer 11

Life-threatening condition where diastolic pressure greater than 130

Question 12

CVD mortality doubles with every __/__ mm Hg blood pressure increase

Answer 12

20/10 mm Hg

Question 13

Automated BP-measuring devices can still measure BP accurately even if the pulse is irregular. True/False?

Answer 13

False
Measure BP manually if pulse is irregular

Question 14

When considering a diagnosis of hypertension, does BP need to be measured in both arms?

Answer 14

Yes

Question 15

If clinic BP is measured at 140/90, what are the next steps?

Answer 15

ABPM/HBPM to confirm diagnosis

Question 16

Define Stage 1 hypertension

Answer 16

Clinic BP = 140/90
+ ABPM/HBPM = 135/90

Question 17

Define Stage 2 hypertension

Answer 17

Clinic BP = 160/100
+ ABPM/HBPM = 150/95

Question 18

Define Stage 3 (severe) hypertension

Answer 18

Clinic systolic BP = 180
OR
Clinic diastolic BP = 110

Question 19

For all hypertensive patients, which tests would you offer to better assess CVD risk?

Answer 19

Test urine (for protein)
Take bloods (glucose, electrolytes, creatinine)
Examine fundi (retinopathy)
Do an ECG

Question 20

What is hypertensive retinopathy?

Answer 20

Narrowing of retinal arterioles, increasing the risk of haemorrhage, hard exudates and papilloedema

Question 21

For patients under 80, what is the target BP in response to drug treatment?

Answer 21

Less than 140/90

Question 22

For patients over 80, what is the target BP in response to drug treatment?

Answer 22

Less than 150/90

Question 23

What is the drug treatment algorithm for hypertension?

Answer 23

A/C
A+C
A+C+D
A+C+D+B

Question 24

Which drug would you prescribe to a 54 year old with hypertension?

Answer 24

ACEi

Question 25

Which drug would you prescribe to a black guy with hypertension?

Answer 25

Ca++ blocker

Question 26

Which drug would you add onto a black guy already on an ACEi and Ca++ blocker whose hypertension is still not controlled?

Answer 26

Thiazide diuretic

Question 27

Treating hypertension is cheaper than doing nothing. True/False?

Answer 27

True, apparently

Question 28

Give some examples where “resistant hypertension” may occur

Answer 28

Non-concordance
White coat hypertension
Poor lifestyle
Secondary hypertension