Hypertension

Question 1

Definition

Answer 1

BP > 140/90 mmHg - Clinic
BP 135/85 mmHg - ABPM

Question 2

Epidemiology

Answer 2

Men
35 +

Question 3

Risk factors

Answer 3

Modifiable -
- Smoking
- Alcohol intake
- Sedentary lifestyle
- DM
- Sleep apnoea
Non-modifiable
Age (+65)
Fhx
Ethnicity (Afro Caribbean)

Question 4

Aetiology (ROPiE)

Answer 4

95% idiopathic (essential HTN)
5% = ROPE
Renal disease
Obesity
Pregnancy (pre-eclampsia)
Endocrine
- Conns = most common cause of secondary HTN
- Pheochromocytoma
- Cushings

Question 5

Pathophysiology

Answer 5

All mechanisms with increased RAAS + SNS activity + Total peripheral resistance = increased BP. As BP = CO * TPR
Thickening of the media of muscular arteries = resulting in endothelial cell dysfunction associated with impaired NO (mediates vasodilation) + enhanced secretion of vasoconstrictors including ENDOTHELINS + PROSTOGLANDINS

Question 6

Signs and symptoms

Answer 6

Usually asymptomatic - found on screening
- May have pulsatile headache
- Also consider signs of secondary cause (pheochromocytoma, cushings)
Retinopathy
Dyspnoea
Chest pain
Headache
Visual changes

Question 7

MALIGNANT HYPERTENSION

Answer 7

Markedly raised diastolic (180/120), rare but concerning px: Black males 30-40
- HF (LVH)
- Blurred vision (papilledema, retinal haemorrhage)
- Renal failure (glomerulonephritis)
- Headache, risk of cerebral haemorrhage
Nothing to do with to do with cancer, just causes v acute severe Sx

Question 8

Staging of HTN

Answer 8

Stage 1 - 140/90 (H) or 135/85 (A)
Stage 2 - 160/100 (H) or 150/95 (A)
Stage 3 - 180 and/or 110 - start immediate treatment!!!

Question 9

Diagnosis

Answer 9

FIRST LINE = BP reading in Hospital 140/90 + mmHg
Then ABPM for 24 hours to confirm diagnosis (BP 135/85 + throughout day)
Assess organ damage (more damage = worse prognosis + more severe)
- fundoscopy - papilloedema
- urinalysis - eGFR, serum creatinine, glucose - renal function + diabetic risk
- ECHO/ECG - LVH

Question 10

Treatment (LESS THAN 55 or T2DM OF ANY RACE)

Answer 10

FIRST LINE = ACE-I (or angiotensin II receptor antagonist if CI)
2 = Add CCB or Thiazide diuretic
3 = (ACE-I or ARB) + CCB + TLD (Indapamide more potent, bendroflumethiazide less potent)
4 = ACE-I + CBB + TLD + Either…
- if K+ > 4.5 = a/b blocker
- if K+ < 4.5 = spironolactone (K+ sparring)

Question 11

If MORE than 55 years old or Black African what drug is first line

Answer 11

CCB

Question 12

If patient black + has T2DM what drug takes precedence

Answer 12

ACE-I

Question 13

Side effect of ACE-I

Answer 13

Dry cough

Question 14

Complication

Answer 14

HF,
IHD risk increased if susceptible patient,
CKD,
Cerebrovascular accident risk increased,