Hypertension

Question 1

What BP value is defined as hypertension?

Answer 1

140/90 clinic or 135/85 ambulatory

Question 2

What percentage of hypertension is primary?

Answer 2

95%

Question 3

What are the causes of secondary hypertension? (ROPE)

Answer 3

• Renal disease
• Obesity
• Pregnancy
• Endocrine, most endocrine conditions cause hypertension

Question 4

What test can be used to check if hypertension is caused by hyperaldosteronism?

Answer 4

renin:aldosterone ratio (blood test)

Question 5

What are the common complications of hypertension?

Answer 5

• ischaemic heart disease
• Cerebrovascular accident
• hypertensive retinopathy
• hypertensive nephropathy
• heart failure

Question 6

What is white coat syndrome?

Answer 6

higher than normal BP reading when in a doctors office due to stress of being there can increase by more than 20/10 mmHg

Question 7

How often should someone without hypertensions BP be checked?

Answer 7

every 5 years

of at higher risk more often

Question 8

If someone has a clinic blood pressure of above 140/90 mmHg what should be the next step in diagnosis?

Answer 8

24 hour ambulatory BP or home reading

Question 9

What are the stages of hypertension?

Answer 9

stage 1 - 140/90 (clinic) 135/85 (a)
stage 2 - 160/100 (clinic) 150/95 (a)
stage 3 - 180/120 (clinic)

Question 10

What further tests should be done when a patient has confirmed hypertension to check for organ damage?

Answer 10

• Urine albumin: creatine ratio and dipstick (kidney damage)
• Bloods: HbA1c, renal function and lipids
• Fundus examination (hypertensive retinopathy)
• ECG (cardiac abnormalities)

Question 11

What medications are used for hypertension?

Answer 11

• ACE inhibitors
• Beta blockers
• Calcium channel blockers
• Thiazide like diuretics
• ARBs

Question 12

Give an example of an ACE inhibitor?

Answer 12

ramipril

Question 13

Give an example of a Beta blocker?

Answer 13

Bisoprolol

Question 14

Give an example of a calcium channel blocker?

Answer 14

Amlodipine

Question 15

Give an example of a thiazide like diuretic?

Answer 15

Indapamide

Question 16

Give an example of an ARB?

Answer 16

Candesartan

Question 17

When are ARBs used instead of ACE inhibitors?

Answer 17

• if ACE inhibitors not tolerated due to dry cough for example
• black African or African-Caribbean patients

Question 18

What lifestyle advice should be offered to patients diagnosed with hypertension?

Answer 18

• healthy diet
• stop smoking
• reduce alcohol
• reduce caffeine
• reduce salt intake
• take regular exercise

Question 19

Who should be offered treatment for their hypertension?

Answer 19

• Anyone with stage 2

- Stage 2 and under 80 and Qrisk above 10% or who has diabetes, renal disease, CV disease or organ damage

Question 20

What are the first, second, third and fourth line treatments for non-black patients under 55?

Answer 20

1) ACE inhibitors
2) ACE inhibitors + CCB or ACE + Diuretics or CCB + Diuretics
3) ACE + CCB + Diuretics
4) ACE + CCB + Diuretics + either potassium sparing diuretic, alpha blocker or beta blocker

Question 21

What are the first, second, third and fourth line treatments for black patients or anyone over 55?

Answer 21

1) CCB
2) CCB + ARB
3) ARB + CCB + Diuretic
4) ARB + CCB + Diuretic + either potassium sparing diuretic, alpha blocker or beta blocker

Question 22

How should the additional medication given in fourth line treatment be chosen?

Answer 22

Serum potassium below 4.5 mmol/l give potassium sparing diuretic if above then alpha or beta blocker

Question 23

Give an example of an alpha blocker?

Answer 23

Doxazosin

Question 24

Give an example of a beta blocker?

Answer 24

Atenolol

Question 25

What is the action of spironolactone and what does it cause?

Answer 25

Blocks action of aldosterone in the kidneys resulting in sodium excretion and potassium reabsorption so “potassium sparing”

Question 26

What drugs can cause a potassium imbalance?

Answer 26

Hyperkalaemia = Spironolactone and ACE inhibitors
Hypokalaemia = thiazide diuretics
(important to check U&Es for all)

Question 27

What are the treatment targets for hypertension?

Answer 27

<80 years = below 140/90

>80 years = below 150/90