Hypertension

Question 1

What are the two types of hypertension

Answer 1

Essential hypertension- no known cause
Secondary hypertension- known causes such as
* OSA
* CKD
* drugs
* Cushing
* coarctation of aorta
* thyroid disease
* pheochromoctyoma
Suspect secondary in young or older OR resistant to meds

Question 2

What might a high blood pressure result in

Answer 2

MI
HF
Stroke
Kidney disease
Use of antihypertensive agents decreases this risk.

Question 3

A patient presents with a blood pressure of 150/95 and bloodwork reveals a serum K of 3.1. What diagnosis are you suspecting

Answer 3

High blood pressure and Hypokalemia
= Hypoaldosteronism due to adrenal dysfunction

Question 4

What is hypertensive emergency vs urgency? How would you manage these conditions?

Answer 4

A hypertensive emergency is an extremely high blood pressure with evidence of end organ damage

Hypertensive urgency is a high blood pressure > 180/110with no evidence of end organ damage

Hypertensive emergency needs to be treated immediately using nicardipine in ICU

Hypertensive urgency can use 1-2 oral agents.

The goal is to lower the BP gradually ~20 percent. Fast lowering can result in ischemic stroke

Question 5

Describe side effects of ACE-i

Answer 5

cough
angioedema
fatigue
hyperkalemia
increased creatinine (measure K and Creat using labs after starting)

Question 6

How might you conduct an evaluation for end organ damage in a patient presenting with blood pressures over 180/110?

Answer 6

ECG and tropes for MI
UA for sediment
Lab chemistries
Dilated retinal exam

Additional investigations if warranted eg. CT head only if severe neuro deficits like hemiparesis