Hypertension

Question 1

What BP values is considered hypertension?

Answer 1

BP of 140/90 in clinic, or 135/85 with home readings

Question 2

1) What is essential hypertension/primary hypertension?
2) What is secondary hypertension?
3) Which of these is the most common?
4) Name 3 causes of primary hypertension
5) Name 2 causes of secondary hypertension
6) What is the commonest cause of secondary hypertension?

Answer 2

1) Hypertension that’s developed on its own and doesn’t have a secondary cause
2) Hypertension caused by another medical condition
3) Primary hypertension (95%)
4) Older age, diabetes, diet high in salt, family history, obesity and sedentary lifestyle
5) Renal disease, obesity, pregnancy induced/pre-eclampsia, hyperaldosteronism (Conn’s syndrome)
6) Renal disease

Question 3

Name 2 complications of hypertension

Answer 3

• Ischaemic heart disease
• Cerebrovascular accident (stroke)
• Hypertensive retinopathy
• Hypertensive nephropathy
• Heart failure

Question 4

Name 3 tests that’s recommended for patients that have had a diagnosis of hypertension, and why these tests are important/what are these tests looking for?

Answer 4

• Urine albumin: creatinine ratio for proteinuria
• Urine dipstick: microscopic haematuria for kidney damage
• Blood tests: HBA1C, renal function and lipid profile
• Fundus examination: hypertensive retinopathy
• ECG: cardiac abnormalities

Question 5

Name 3 lifestyle changes for patients with hypertension

Answer 5

• Smoking cessation
• Alcohol cessation
• Decreased salt intake + diet lower in fat
• Increased physical activity
• Weight loss

Question 6

Medical management
1) What is step 1 of medical management?
2) What is step 2 of medical management?
3) What is step 3 of medical management?
4) What is step 4 of medical management?

Answer 6

1) If under 55, ACE inhibitor or ARB if ACEi intolerant is 1st line. If 55 or older, or black ethnicity of any age, CCB (dihydropyridine) is 1st line.
2) ACEi + CCB. Alternatively ACEi + thiazide diuretic or CCB + thiazide diuretic. If patient is of black ethnicity use ARB instead of ACEi.
3) ACEi + CCB + thiazide diuretic
4) ACEi + CCB + thiazide diuretic. If serum potassium is less than 4.5mmol/L - potassium sparing diuretic but if serum potassium is more than 4.5mmol/L - alpha blocker or beta blocker

Question 7

What clinic BP, and ambulatory/home BP monitoring average measurement of BP is considered mild and moderate hypertension?

Answer 7

• Mild = clinic >140/90 mmHg and ambulatory/home >135/85 mmHg
• Moderate = clinic >160/100 mmHg and ambulatory/home >150/95 mmHg

Question 8

What is the criteria for severe hypertension?

Answer 8

> 180 mmHg systolic or >120 mmHg diastolic in clinic

Question 9

If a patient presents with severe BP (>180/120 mmHg) + no worrying signs, what 3 tests are done, and what are these tests checking for?

Answer 9

ECG, urine dip and blood tests. Checking for end organ damage

Question 10

If a patient presents with severe BP (>180/120 mmHg), name 2 additional features that would warrant same day specialist assessment

Answer 10

• Papilloedema/retinal haemorrhage
• Suspected pheochromocytoma
  also if there’s life threatening symptoms such as:
• New onset confusion
• Chest pain
• Signs of HF
• AKI