Hypertension

Question 1

How common is hypertension?

Answer 1

-1 in 4 adults
-More common in 45-65 y/o men
-More common in >75 y/o women

Question 2

What causes HTN?

Answer 2

-Primary HTN is most common and the direct cause is unknown
-Causes of secondary HTN:
–Renal disease (glomerulonephritis)
–Cushing’s, Conn’s, thyroid dysfunction
–Pre-eclampsia / pregnancy
–Drugs eg COCP, cocaine, ciclosporin
–Obesity

Question 3

What risk factors are there for HTN?

Answer 3

-Smoking
-Obesity
-High salt intake
-Lack of exercise
-Stress
-Alcohol
-FH

Question 4

How does HTN present?

Answer 4

Stage I = BP 135/85 - 149/94
Stage II = 150/95 or more
-Usually asymptomatic unless accelerated / malignant –> end organ damage eg nephropathy, papilloedema, dissection, pulmonary oedema

Question 5

How would you investigate a patient with suspected HTN?

Answer 5

-HBPM / ABPM to confirm HTN
-Urine dip for protein / blood
-eGFR
-Renal USS
-ECG (LVH / CHD)
-TFTs / dexamethasone suppression test / urinary free cortisol
-Fundoscopy
-Q-RISK

Question 6

What treatment would you consider for someone with suspected HTN?

Answer 6

-Lifestyle advice (weight, caffeine, salt, alcohol)
-Refer for same-day specialist review if >180/120
Pt <55 and caucasian?
-ACEi or ARB
-Ramipril 2.5mg initially, check renal function 1 week after starting incase of renal artery stenosis
-SEs = syncope, palpitations, GI discomfort, dry cough
Pt >55 and black?
-Give CCB
-Amlodipine 5mg
-SEs = dizziness, palpitations, flushing, abdo pain, peripheral oedema
HF?
-Give thiazide diuretic
No response?
-Increase dose or A+C+D
-Allow interval of 4 weeks to determine response