Hypertension

Question 1

Values?

Answer 1

Optimal - <120/80 
Normal -130/85
High normal-140/90
Grade 1 -160/80
Grade 2-180/90
Grade 3->180/90
Isolated systolic htn- >140/<90
Target -140/90 then 130/80

Question 2

Symptoms of HTN?

Answer 2

usually asymptotic 
Headache 
Sweating
Palpitation 
Epitaxis
SOB
Malignant htn- severe headache visual disturbance,fits,transient LOC

Question 3

Secondary Causes of HTN?

Answer 3

Lifestyle-diet,lack of exercise 
Drugs-alchohol, bp increasing drugs,poor adherence 
Metabolic- obesity 
Vascular- COA
Renal-renal artery stenosis, CKD
Endocrine-cons,hypercortisolaemia, phaechromocytoma, acromegaly, hyper/hypo thyroidism
Respi- obstructive sleep apnea
Neuro-autonomic failure 
Obstretic- pregnancy

Most common secondary causes
Hyperaldosteronism
Obs sleep apnea
Obesity

Question 4

How to check the compliance of the drugs?

Answer 4

1. morisky medication adherence scale
2. Prescription refill rate
3. Drug analytical test on plasma or urine

Question 5

Anti hypertensive drugs

Answer 5

1. ACEI/ARB
2. CCB
3. thiazide like diuretic
4. spironolactone

Question 6

Features of hypertensive retinopathy?

Answer 6

Grade 1- arteriolar thickening, tortuousity, increased reflective ness
Grade 2- grade 1+ AV nipping
Grade3- 2+ evidence of retinal ischemia (flame hemorrhage, cotton wool spots)
Grade 4- 3+ papilloedema

Question 7

Mx of HTN?

Answer 7

1.lifestyle modifications
DASH diet, salt restriction, weight reduction, exercise, reduce alcohol, stop smoking, high k, asses cardiovascular risk
2. Pharmacological management
Indications-
Consider High norm bp with high cardiovascular risk
Start for grade 1 with high CVR/organ damage / CKD/ no control with lifestyle modifications for 3-6 months
Start for all grade 2 and 3
Irrespective of comorbidities, > 80 y tx threshold is 160/90
Mono therapy indications-
SBP<150 and low risk
High Norma bp with a very high cv risk
Old frail people

1. ACEI/ARB + CCB/diuretic
2. ACEI/ARB + CCB + diuretic
3. Add spironolactone