Hypertension

Question 1

What BP is the NICE guidelines diagnosis BP for HTN?

Answer 1

140/90 – clinic
135/85 – ambulatory / home

Question 2

What are the risk factors for HTN? (7 things)

Answer 2

1. Male
2. Age
3. FHx
4. Smoking / Alcohol
5. Obesity
6. High Na diet
7. Physical inactivity

Question 3

What are the causes of secondary HTN? (4 things)

Answer 3

1. R – Renal disease
2. O – Obesity
3. P – Pregnancy induced HTN / Pre-eclampsia
4. E – Endocrine

ROPE

Question 4

What Renal disease causes secondary HTN?

Answer 4

Renal artery stenosis

Question 5

What is the most common Endocrine cause of secondary HTN?

Answer 5

Hyperaldosteronism

Question 6

How do you check if Hyperaldosteronism is the cause of the secondary HTN?

Answer 6

Renin:aldosterone ratio blood test

Question 7

How do you confirm the diagnosis of HTN of a patient with clinic BP between 140/90 – 180/120?

Answer 7

24 hour ambulatory BP / home reading

Question 8

What are the Clinic and Ambulatory/Home readings for Stage 1 HTN?

Answer 8

Clinic = >140/90
Ambulatory/Home = >135/85

Question 9

What are the Clinic and Ambulatory/Home readings for Stage 2 HTN?

Answer 9

Clinic = >160/100
Ambulatory/Home = >150/95

Question 10

What is the reading for Stage 3 HTN?

Answer 10

180/120+

Question 11

What investigations should be done to check for End Organ Damage for newly diagnosed HTN patients? (5 things)

Answer 11

1. Fundus examination
2. ECG
3. Bloods
4. Urine dipstick
5. Urine albumin:creatinine ratio

Question 12

What are you checking for in Urine albumin:creatinine ratio for newly diagnosed HTN patients?

Answer 12

Proteinuria

Question 13

What are you checking for in Urine dipstick for newly diagnosed HTN patients? (2 things)

Answer 13

1. Haematuria
2. Kidney damage

Question 14

What are you checking for in Bloods for newly diagnosed HTN patients? (3 things)

Answer 14

1. HbA1c
2. Renal function
3. Lipids

Question 15

What are you checking for in Fundus examination for newly diagnosed HTN patients?

Answer 15

Hypertensive retinopathy

Question 16

What are you checking for in ECG for newly diagnosed HTN patients?

Answer 16

Cardiac abnormalities

Question 17

What are all the medications used for HTN? (5 things)

Answer 17

1. A – ACE inhibitors (e.g. Ramipril 1.25 – 10mg once daily)
2. B – Beta blockers (e.g Bisoprolol 5 – 20mg once daily)
3. C – Calcium channel blocker (e.g Amlodipine 5 – 10mg once daily)
4. D – Thiazide-like Diuretic (e.g Indapamide 2.5mg once daily)
5. ARB – Angiotensin II Receptor Blocker (e.g Candesartan 8 – 32mg once daily)

Question 18

When are ARBs used in HTN?

Answer 18

Instead of ACE inhibitor if patient: nigga or doesn’t tolerate ACE inhibitors
ACE inhibitors and ARBs are NOT used together

Question 19

What is the initial management of HTN? (3 things)

Answer 19

1. Establish diagnosis
2. Investigate for Causes + End Organ Damage
3. Lifestyle advice

Question 20

Who is offered MEDICAL management for HTN? (2 things)

Answer 20

1. Under 80 yrs w Stage 1 HTN + Q-risk score 10+% / DM / Renal/CVS Disease / End Organ Damage
2. All Stage 2 HTN patients

Question 21

What is the step wise approach to HTN medication? (4 steps)

Answer 21

Step 1: A (less than 55yrs + white) / C (55+ / nigga)
Step 2: A + C (white) / ARB + C (nigga)
Step 3: A + C + D

Step 4:
Serum K less than 4.5 = A + C + D + Spironolactone (K sparing diuretic)
Serum K more than 4.5 = A + B/alpha blocker + C + D

Question 22

What is a complication of Spironolactone?

Answer 22

Hyperkalaemia

Question 23

What is a complication of ACE inhibitors?

Answer 23

Hyperkalaemia

Question 24

What is a complication of Thiazide-like diuretics?

Answer 24

Electrolyte disturbances

Question 25

What should you monitor when using ACE inhibitors and diuretics on HTN patients?

Answer 25

U&Es regularly

Question 26

What is the treatment target for a HTN patient who is younger than 80?

Answer 26

Less than 140/90

Question 27

What is the treatment target for a HTN patient who is older than 80?

Answer 27

Less than 150/90

Question 28

What are the complications of HTN? (5 things)

Answer 28

1. Stroke / brain haemorrhage
2. Hypertensive retinopathy
3. Ischaemic heart disease
4. HF
5. Hypertensive nephropathy