Hypertension

Question 1

Causes of HTN

Answer 1

Most is essential HTN

ROPE mnemonic

R- renal disease e.g. renal artery stenosis
O - obesity
P - pregnancy-induced/pre-eclampsia
E - endocrine e.g. Conn’s, phaeo

Question 2

When should specialist investigations be considered for HTN for potential secondary cause?

Answer 2

If under 40

If HTN not responding to full medical management

Question 3

Complications of HTN

Answer 3

Ischaemic heart disease
Cerebrovascular accident (i.e. stroke or haemorrhage)
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure

Question 4

Diagnosis and investigations for HTN

Answer 4

BP reading in clinic

If high - 24h ambulatory BP monitoring to confirm diagnosis

In patients with new diagnosis:

• Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess for kidney damage
• Bloods for HbA1c, renal function and lipids
• Fundus examination for hypertensive retinopathy
• ECG for cardiac abnormalities

Question 5

Management of HTN

Answer 5

First line:

• ACEi for anyone under 55 or who has T2DM unless they are or Black origin
• CCB for anyone over 55 or of black origin

Second:

• ACEi plus CCB (or Thiazide diuretic)
• CCB plus ARB in black patients

Third:
- ACEi/ARB plus CCB plus thiazide diuretic

Fourth:

• Consider adding in potassium sparing diuretic e.g. spironolactone
• Specialist review

Question 6

Treatment targets

Answer 6

<80 years old - aim for <140/<90

> 80 years old - aim for <150/<90