Hypertension

Question 1

Causes of hypertension

Answer 1

Essential/primary (95%)
ROPE
Renal disease - renal artery stenosis
Obesity
Pregnancy induced/pre-eclampsia
Endocrine - Conns (hyperaldosteronism) - renin: aldosterone blood test

Question 2

Complications of hypertension

Answer 2

Ischaemic heart disease
CVA
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure

Question 3

Screening of hypertension

Answer 3

Every 5 years
More often if diabetic/borderline

Question 4

White coat effect

Answer 4

> 20/10 mmHg difference in BP between clinic and ambulatory/home readings

Question 5

Diagnosis of hypertension

Answer 5

> 140/90 in clinic
135/85 at home
Measure in both arms –> if >15 mmHg difference take highest reading

Question 6

Stages of hypertension

Answer 6

1 = >140/90 clinic = >135/85 home
2 = >160/100 = > 150/95
3 = >180/120 clinic

Question 7

Investigations of hypertension

Answer 7

If potential secondary cause / under 40 = specialist investigations
New diagnosis:
Urine albumin:creatinine ratio for proteinuria
Urine dipstick for haematuria (kidney damage)
HbA1c, renal function, lipids
Fundus examination
ECG

Question 8

Initial management of hypertension

Answer 8

Diagnose
Investigate for causes/end organ damage
Advise on lifestyle

Question 9

Hypertension medical management indications

Answer 9

Stage 2
Under 80 years old + Q risk score of 20%+, diabetes, renal disease, CVD or end organ damage

Question 10

Medical management of hypertension

Answer 10

Step 1:
<55/non-black = ACEi (ramipril 1.25-10mg OD)
>55/black = CCB (amlodipine 5-10mg OD)
Step 2:
ACEi + CCB or ACEi/CCB + thiazide-like diuretic (indapamide 2.5mg OD)
if black = angiotensin II receptor blocker (candesartan 8-32mg OD) instead of ACEi
Step 3:
ACE/ARB + CCB + TLD
Step 4:
Serum potassium </=4.5mmol/l = potassium sparing diuretic (spironolactone)
If > 4.5mmol/l = alpha blocker (doxazosin) or beta blocker (atenolol)
Step 5: seek specialist advice

Question 11

Spironolactone mechanism

Answer 11

Blocks aldosterone action in kidneys
Sodium secretion and potassium reabsorption
Helpful if thiazide diuretics are causing hypokalaemia
Increase risk of hyperkalaemia along with ACEi
Monitor U+Es regularly

Question 12

Hypertension treatment targets

Answer 12

< 80 years old = <140/<90
> 80 years = <150/<90