hypertension

Question 1

what is hypertension

Answer 1

• term used to describe high blood pressure
• 140/90 in clinic or 135/85 with ambulatory or home readings.

Question 2

RISK factors for hyoertension

Answer 2

Modifiable ;
Alcohol
Sedentary lifestyle
DM
sleep apnoea
Smoking

Non mod ;
Age
Fhx
Ethnicity

Question 3

causes of hypertension

Answer 3

primary hypertension 95% of cases - develops on its own and no secondary cause

Question 4

what are the secondary causes of hypertension

Answer 4

R – Renal disease. This is the most common cause of secondary hypertension.
O – Obesity
P – Pregnancy induced hypertension / pre-eclampsia
E – Endocrine.

Question 5

why do most endocrine conditions cause hypertension

Answer 5

Due to hyperaldosteronism

Question 6

complications of hypertension

Answer 6

Ischaemic heart disease
Cerebrovascular accident (i.e. stroke or haemorrhage)
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure

Question 7

Monitoring of patients with a diagnosis of HT

Answer 7

NICE recommendation - blood pressure every 5yrs
every year for patients with T2DM

Question 8

Patients with a clinic blood pressure between 140/90 mmHg and 180/120 mmHg should…?

Answer 8

have a 24hr ambulatory blood pressure or home readings to confirm the diagnosis

Question 9

why does having blood pressure taken by a doctor or nurse usually have a higher reading

Answer 9

white coat syndrome - defined as more than a 20/10 mmHg difference in blood pressure between clinic and ambulatory or home readings

Question 10

stages of hypertension

Answer 10

Stage 1 Hypertension C >140/90 A/H>135/85

Stage 2 Hypertension C>160/100 A/H >150/95

Stage 3 Hypertension C>180/120

Question 11

NICE recommend all patients with a new diagnosis should have

Answer 11

-Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess for kidney damage
-Bloods for HbA1c, renal function and lipids
-Fundus examination for hypertensive retinopathy
-ECG for cardiac abnormalitie

Question 12

WHEN TO REFEr

Answer 12

BP >180/20 +
signs of accelerated hypertension
life threatening feautures
suspected phaeochromocytoma

Question 13

initial management of HT

Answer 13

• establish a diagnosis
• investigate for possible causes and end organ damage
• advise on lifestyle

Question 14

who is medical management offered to

Answer 14

All patients with stage 2 hypertension

All patients under 80 years old with stage 1 hypertension that also have a Q-risk score of 10% or more, diabetes, renal disease, cardiovascular disease or end organ damag

Question 15

different guidelines for over 55 and black

Answer 15

step 1 =C
STEP 2= ARB+C
STEP 3= A+C+D
STEP 4= A+C+D+ 4th drug

Question 16

what 4th drug would you consider for step 4

Answer 16

is K is less than or equal to 4.5 then spironolactone
if more than 4.5 then alpha or beta blocler

Question 17

side effects of spironolactone

Answer 17

hyperkalaemia

Question 18

why may a patient be switched from an ace inhibitor to ARB

Answer 18

ACE CAUSES a dry cough due to increased bradykinin

Question 19

treatment targets

Answer 19

younger than 80 140/90
older than 80 150/90

Question 20

35yr old female presents with palpitations , headaches, sweating and anxiety

BP 180/100 mg

what is the most likely diagnosis

Answer 20

phaeochromocytoma

Question 21

What changes can occur in primary hypertension

Answer 21

loss of elastin in arteries due to age

Question 22

what are some secondary causes of htn

Answer 22

glomerulonephritis
adult pkd
cushings
nsaids
pregnancyy

Question 23

treatment pathway for over 55 and diabetic

Answer 23

step 1- A
step 2 A+c or A+D
step 3- A+C+D
Step 4- if k+ < = 4.5 add low dose spironolactone
more than 4.5 then add alpha or beta blocker

Question 24

SE of ccb

Answer 24

flushing
ankle swelling
headache

Question 25

SE of acei

Answer 25

cough
angiodema
hyperkalaemia

Question 26

most common cause of secondary htn

Answer 26

renal disease
pkd