Hypertension

Question 1

Hypertension stages

Answer 1

Clinic
1 - 140/90 ( 135/85)
2- 160/100 (150/95)
3- 180 or diastolic 120

Question 2

HTN Dx

Answer 2

Diagnosed over time
Clinic BP reading >/=140/90
and ABPM/HBPM >/=135/85

Question 3

‘Refer people for specialist assessment, carried out on the same day, if

Answer 3

they have a clinic blood pressure of 180/120 mmHg and higher
- with signs of retinal haemorrhage or papilloedema (accelerated hypertension).
Or
- confusion, chest pain ,heart failure signs ,aki

Question 4

Home vs Ambulatory BPM

Answer 4

Ambulatory = 2 readings per hour, 14 readings in waking hours required

Home BPM = continues for 7 days with readings in AM,afternoon and pM

Question 5

HTN lifestyle advice

Answer 5

Diet and exercise
Decrease caffeine
Decrease dietary sodium
Stopping smoking
Reduce alcohol

Question 6

Offer antiHTN medication if patient stage 1,<80, and has one of the following

Answer 6

target organ damage
Diabetes
Renal disease
Cardiovascular disease
QRISK >10%

otherwise lifestyle changes

Question 7

First line in diabetics

Answer 7

ACE-i due to renoprotective properties

Question 8

anti HTN treatment algorithm steps 1-3

Answer 8

Step 1:
a. <55 years & not black or with type 2 diabetes= ACEi or ARB
b. >55 or black patients of African/Carribean descent = Ca channel blocker

Step 2:
a. A +C or A+D
b. C+A or C+D

Step 3: A+C+D

Question 9

Step 4 anti HTN Mx

Answer 9

regard them as having resistant hypertension
- reconfirm recordings
- Assess for postural hypotension
- Discuss adherence
- low-dose spironolactone if blood potassium level of 4.5 mmol/l or less
- alpha-blocker or beta-blocker if blood potassium level of more than 4.5 mmol/l

Question 10

HTN targets if they have organ damage ACR of >70 and t1 diabetes

Answer 10

130/80 (140/90 if no organ damage)

if >80 years, whatever the ACR aim for 150/90

Question 11

HTN targets

Answer 11

< 80, reduce clinic blood pressure to below 140/90 mmHg (135/85)
> 80 reduce clinic blood pressure to below 150/90 (145/85)

Question 12

ACEi side effects

Answer 12

First dose hypotension
Persistent cough
Angioedema

egs: Ramipril, captopril, enalapril

Question 13

CCB side effects

Answer 13

Peripheral oedema
Heart block

egs: Amlodipine, nifedipine (affect peripheral arteries) verapamil, diltiazem, flunarizine (affects heart Aswell)

Question 14

Thiazide like diuretic side effects

Answer 14

Hyponatraemia
Hypokalaemia
Gout (hyperuricaemia)

egs: bendrofluemthiaze and chlortalidone

Question 15

Malignant HTN

Answer 15

Blood pressure rises rapidly causing end organ damage
above 180/120
Presents with headache or visual blurring

Question 16

Causes of malignant HTN

Answer 16

Missing doses of BP medication
Kidney disease
Spinal cord injuries
Birth control pills OCP
Drugs: cocaine
Tumour of adrenal gland (release of aldosterone)

Question 17

Malignant HTN Mx

Answer 17

controlled drop in blood pressure, to around 160/100mmHg over at least 24 hours
Oral medication is preferred to IV, unless there is encephalopathy, heart failure or aortic dissection. Oral calcium channel blockers such as amlodipine or nifedipine are often used first line
Hypertensive encephalopathy - IV Labetalol or IV infusion Sodium Nitroprusside.

Question 18

Malignant HTN Cx

Answer 18

Death from renal failure- proteinuria, heamaturia
Hypertensive encephalopathy- cerebral oedema, haemorrhage

Question 19

If clinic BP under 140/90

Answer 19

Check BP at least every 5 years and more often if close to 140/90 mmHg