Hypertension

Question 1

What is essential hypertension

Answer 1

primary hypertension

no specific disease causing rise in BP e.g. a renal or endocrine disorder

Question 2

Signs and symptoms

1. When would someone typically experience hypertensive symptoms?
2. What symptoms can be experienced?

Answer 2

1. not until BP very high e.g. >200/120
2. • headache
   • visual disturbances (e.g. retinal haemorrhage)
   • seizures

Question 3

What tests can be done on diagnosis of hypertension

Answer 3

• U+Es + urine dipstick: to look for renal disease as cause or consequence of hypertension
• fundoscopy: to check fro hypertensive retinopathy
• ECG: for LVH or signs of ischaemic heart disease

check for risks for CV disease:

• HbA1c
• lipids

Question 4

Blood Pressure Classification

Define

1. Stage 1 hypertension
2. Stage 2 hypertension
3. severe hypertension

Answer 4

1. clinic average >/=140/90 or ambulatory / home blood pressure average >/=135/85
2. clinic average >/=160/100 or ambulatory / home blood pressure average >/=150/95
3. clinical average >180 systolic OR >110 diastolic

Question 5

What lifestyle advice should be given to patients?

Answer 5

• reduce salt intake to <6g/day ideally <3g/day
• reduce caffeine intake
• general: lose weight, exercise more, stop smoking, reduce drinking + eat balanced diet

Question 6

When should someone with hypertension be given pharmacological therapy?

Answer 6

stage 2 or more

stage 1, <80 years old and with one of the following:

• established CV disease
• target organ damage
• renal disease
• diabetes
• 10 year risk of CV event >/=10%

Question 7

Describe each of the 4 steps of hypertension management.

Answer 7

step 1:
<55 years old - ACE or ARB
>/=55 years old or of afro-caribbean origin - CCB

step 2: 
any 2 of 
- ACE or ARB
- CCB 
- Thiazide-LIKE diuretic 

Notes:

• ARB not ACE if afro-caribbean
• thiazide-like diuretic NOT simply thiazide diuretic I.e. indapamide not bendroflumethazide

step 3:
all 3 from step 2

step 4
K+ <4.5 - spironolactone
K+ >4.5 - give alpha or beta blocker

Question 8

What should be the blood pressure target for hypertensive patients :

1. <80
2. > 80

Answer 8

1. 140/90
   or ambulatory / home 135/85
2. 150/90
   or ambulatory / home 145/85

(adding 10 to ONLY the systolic)

Question 9

Hypertension in Diabetes

1. Targets
   a)
   i) What is the BP target for type 1
   ii) When is this not the case?
   b) What is the BP target for type 2
2. What is the first drug these patients should receive if they require hypertensive control?

NOTE: avoid beta blockers as, especially with thiazides, can impair insulin secretion, cause insulin resistance and alter autonomic response to hypoglycaemia

Answer 9

1. a)
   i) 135/85
   ii) if albuminuria or 2 features of metabolic syndrome then target 130/80

b) 140/90 as per everyone else

2. ACE inhibitor regardless of age
   (ARBs for patients of afro-caribbean ethnicity)

Question 10

What is the most common cause of secondary hypertension?

Answer 10

primary aldosteronism

5-10% of all patients with hypertension