Hypertension

Question 1

What are the values for diagnosing hypertension?

Answer 1

140/90 clinic BP

135/85 ambulatory/home reading BP

Question 2

What percentage of hypertension is essential hypertension/ primary hypertension?

Answer 2

95%

Question 3

What does primary hypertension mean?

Answer 3

It develops on its own, no secondary cause

Question 4

What are the causes of secondary hypertension

Answer 4

ROPE
Renal artery stenosis/ renal disease
Obesity
Pregnancy induced hypertension/ pre-eclampsia
Endocrine - mainly hyperaldosteronism (Conn’s syndrome - the test for this is a renin:aldosterone ratio blood test)

Question 5

What are the complications of hypertension

Answer 5

Ischaemic heart disease 
Cerebrovascular incident - stroke or haemorrhage
Hypertensive retinopathy
Hypertensive nephropathy 
Heart failure

Question 6

Diagnosis of hypertension

Answer 6

Patients should be screened every 5 years for hypertension
Every 1 year if type 2 diabetic
Patients with clinic pressure of between 140/90 - 180/120mmHg –> 24h ambulatory or home readings

Question 7

Stage 1 hypertension is

Answer 7

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

Question 8

Stage 2 hypertension is

Answer 8

> 160/100 clinic >155/95 ambulatory/home

Question 9

Stage 3 hypertension is

Answer 9

> 180/120

Question 10

All pts with new diagnosis of HTN should have

Answer 10

Screening for end organ damage:

Urine albumin: creatinine ratio to look for proteinuria
Dipstick to look for microscopic haematuria - assess kidney damage
Bloods for HbA1c, renal function & lipids
Fundus examination assess retinopathy
ECG for cardiac abnormalities

Question 11

Drugs used to treat hypertension

Answer 11

ACEis - e.g. ramipril 1.25mg OD up to 10mg
ARBs in people who do not tolerate ACEi e.g. candesartan 8mg up to 32mg OD
Beta blockers e.g. bisoprolol 2.5mg up to 20mg
Calcium channel blockers e.g. amlodipine 5mg up to 10mg OD
Diuretic - thiazide-like diuretic e.g. indapamide 2.5mg

Don’t use ACEi and ARBs together

Question 12

Initial management of hypertension

Answer 12

Establish diagnosis
Investigate for possible secondary causes
Advise on lifestyle management - healthy diet, stopping smoking, reducing caffeine salt and alcohol intake
Regular exercise

Question 13

Medical management of HTN is offered to:

Answer 13

All patients with Stage 1 hypertension under 80 with QRISK score >10%, diabetes, renal disease, cardiovascular disease or end organ damage
All patients with Stage 2 hypertension

Question 14

Medical management of hypertension:

Answer 14

Step 1: If <55 and non-black: A =ACEi
Step 1: If >55 or black: C = CCB
Step 2: A +C or A+D or C +D - in black people A = ARB
Step 3: A + C + D
Step 4: A + C +D + additional

Question 15

What is the additional drug in Step 4?

Answer 15

If the K+ is >4.5mmol/l use alpha blocker e.g. doxazosin or beta blocker e.g. atenolol
If K+ is <4.5mmol/l use K sparing diuretic = spironolactone

Question 16

What is the action of spironolactone?

Answer 16

Aldosterone antagonist - so Na is excreted and K reabsorbed

Question 17

Thiazide diuretics have what effect on K+?

Answer 17

Can cause hypokalaemia

Question 18

ACEi and K+ sparing diuretics cause?

Answer 18

Hyperkalaemia

Question 19

What are treatment targets?

Answer 19

<140/90 in under 80 years

<150/90 in over 80 years