hypertension

Question 1

what is stage 1 htn

Answer 1

Clinic > 140/90 + Ambulatory BP average > 135/85

Question 2

What is stage 2 htn

Answer 2

Clinic > 160/100 + Ambulatory BP average > 150/95

Question 3

what is severe htn

Answer 3

Clinic > 180/100 + Ambulatory BP average > 150/95

Question 4

How should you diagnose htn

Answer 4

Measure bp in both arms

Question 5

Once a diagnosis is confirmed, what should pt be investigated for

Answer 5

Target organ damage

Question 6

Different types of htn

Answer 6

Primary- no cause. multifactorial

Secondary- caused by identifiable underlying condition

Question 7

Causes of secondary htn

Answer 7

pre-eclampsia
Renal disease - intrinsic or renovascular (compromised blood supply to kidney due to lesion blocking main renal artery)
Endocrine - Cushing’s, conns, thyroid dysfunction, acromegaly, pheochromocytoma, hyperparathyroidism
Alcohol, cocaine, CoCP, anti-depressant, herbal meds
Coarctation of aorta
Obstructive sleep apnoea

Question 8

what Is htn a risk factor for

Answer 8

Stroke
ISchaemic heart disease
AAA
peripheral arterial disease
Heart failure
Vascular dementia
CkD

Question 9

What is malignant hypertension

Answer 9

Severe htn (>180/120) which develops over a short period of time and end organ damage (e.g. cerebral haemorrhage, acute renal failure, aortic dissection or heart failure

Question 10

What must be present to make a diagnosis of malignant hypertension

Answer 10

Papilloedema

Question 11

What may patient with malignant htn present with

Answer 11

Headache and confusion due to hypertensive encephalopathy

Question 12

What’re the end organ damages that occur due to hypertension

Answer 12

CV events: LVH hypertrophy, diastolic dysfunction, congestive HF

Renal events: renal failure and other renal problems

Retinal events: hypertensive retinopathy

Question 13

`What can happen to the kidney in end organ damage

Answer 13

Glomerular ischaemic changes occur and so can glomerular hyperperfuion injury. Leads to glomerulosclerosis and necrosis

Question 14

Stages of hypertensive retinopathy

Answer 14

I Tortuous arteries with shiny walls (copper/silver wiring)

II A-V nipping – narrowing as arterioles cross veins

III Flame haemorrhages and cotton wool spots

IV Papilloedema

Question 15

Cerebrovascular damage in brain from HTN

Answer 15

Higher risk of
Infarction and haemorrhage

VAscular dementia, stroke, enceph

Question 16

How to look for secondary causes of htn

Answer 16

24h urinary metanephrine
Cortisol
Renin-aldosterone ratio
Calcium
Imaging of renal arteries

Question 17

How to assess for end organ damage

Answer 17

Urine and blood
Renal function
Renal ultrasound
12 lead ECG (LVH)
Echo
Fundoscopy