Hypertension

Question 1

How is HTN diagnosed?

Answer 1

If clinic reading is >140/90 then home monitoring is required
Done by either home readings or ambulatory BP
If these are high then HTN is confirmed and staged

Question 2

What is the staging of HTN?

Answer 2

Stage 1

• Clinic BP >140/90
• Home BP >135/85

Stage 2

• Clinic BP >160/110
• Home BP >150/95

Severe

• Systolic >180
• Diastolic >120

Malignant
->200/120 and signs of end organ failure e.g. flame haemorrhages and exudate on fundoscopy

Question 3

How does ambulatory and home monitoring work?

Answer 3

Ambulatory is where BP is measured at least twice hourly over a 24hr period and average is taken

Home BP monitoring

• done over 7 days
• 2 readings per day- morning and evening
• do it twice each time and use average result
• discard 1st day

Question 4

What are the causes?

Answer 4

Primary 95%
-no underlying cause

Secondary

• obesity
• pregnancy/PET
• Renal disease e.g. renal artery stenosis
• Conns Syndrome
• Raised ICP
• Coarctation of aorta

Question 5

What is the conservative management?

Answer 5

Weight loss
Low salt diet
High fibre diet
Regular exercise
Stop smoking
Decrease alcohol intake

Question 6

What is the medical management?

Answer 6

<55 and white

1) ACEi/ARB
2) ACEi/ARB + CCB
3) ACEi/ARB + CCB + Diuretic
4) ACEi/ARB +CCB + Diuretic PLUS one of following
- if K+ =/<4.5 then spironolactone
- if K+ >4.5 then alpha or beta blocker
5) refer to specialist and consider renal artery stenosis

> 55 or black
1) CCB
2) CCB + ACEi/ARB OR CCB + Diuretic
Then above steps