Hypertension

Question 1

What is the actual definition of hypertension?

Answer 1

The level of blood pressure where treatment does more good than harm

Question 2

How is hypertension diagnosed?

Answer 2

Ambulatory Bloop Pressure Monitoring - 2 measurements per hour for 14 hours a day for 7 days
Home Blood Pressure Monitoring - 2 consecutive seated measurements, 1 minute apart, twice for day for 4-7 days (The mean is then calculated, discarding day 1 measurements)

Question 3

What is meant by the white coat effect?

Answer 3

An increased blood pressure caused by stress in a clinical surrounding

Question 4

What is meant by normotension?

Answer 4

A normal, non-hypertensive blood pressure

Question 5

What is meant by Stage 1 hypertension?

Answer 5

Clinic BP = 140-160 / 90-100 mmHg
AMBP/HBPM = 135-150 / 90-95 mmHg

Question 6

What is meant by stage 2 hypertension?

Answer 6

Clinic BP = 160-180 / >100 mmHg
AMBP/HBPM = >150 / 95-110 mmHg

Question 7

What is meant by severe hypertension?

Answer 7

Clinic systolic BP >180mmHg
AMBP/HBPM diastolic >110mmHg

Question 8

What are some other tests that need to be done in hypertension?

Answer 8

Urine test for proteinuria
Blood test for glucose, electrolytes, creatinine, glomerular filtration rate and cholesterol
Examine funds for hypertensive retinopathy
12-lead ECG

Question 9

What are the 4 grades of hypertensive retinopathy?

Answer 9

Grade I - Slight to modest narrowing of the retinal arterioles (arteriovenous ratio ≥1:2)
Grade II - Modest to severe narrowing of the retinal arterioles (arteriovenous ratio <1:2)
Grade III - Bilateral soft tissue exudates or flame haemorrhages
Grade IV - Bilateral optic nerve oedema

Question 10

What are some test signs of end organ damage?

Answer 10

Left ventricular hypertrophy shown by ST depression of V4-6 on ECG
Raised creatinine
Albuminuria/microalbuminuria
Retinopathy

Question 11

What are the NICE guidelines on target blood pressures?

Answer 11

140/90 mmHg in those under 80
150/90 mmHg in those over 80
(These should be lower!)

Question 12

What are some common secondary causes of hypertension?

Answer 12

• Renal disease
• Obstructive sleep apnoea
• Aldosteronism - autonomous aldosterone release
• Reno-vascular disease - Atheroma of renal arteries causes kidneys to assume low blood pressure

Question 13

How big of a drop in blood pressure is caused by a 1kg weight loss?

Answer 13

1mmHg

Question 14

By how much does 15 minutes of daily physical exercise decrease mortality risk?

Answer 14

14%

Question 15

By how much can the use of effervescent tablets increase the risk of mortality?

Answer 15

2 fold, due to their high Na+ content

Question 16

What are the 4 stages of hypertension treatment in a non-black patient under 55 years old?

Answer 16

Stage 1 - ARB or ACEi
Stage 2 - ARB/ACE and Ca2+ blocker/Diuretic
Stage 3 - ARB/ACE, Ca2+ AND diuretic
Stage 4 - Further diuretics or Alpha blocker or ß-Blocker

Question 17

What are the 4 stages of hypertension treatment in a non-black patient under 55 years old?

Answer 17

Stage 1 - Ca2+ blocker or diuretic
Stage 2 - ARB/ACE and Ca2+ blocker/Diuretic
Stage 3 - ARB/ACE, Ca2+ AND diuretic
Stage 4 - Further diuretics or Alpha blocker or ß-Blocker

Question 18

What is meant by a teratogen?

Answer 18

A substance that can cause congenital abnormalities during foetal formation and development

Question 19

Why are young women not usually given ACEis or ARBs?

Answer 19

They can be teratogenic so could prevent them being able to have children. They are only given to those who are sterilised or are sure that they do not want children

Question 20

What happens to side effect risk as doses of ARBs and ACEis are increased?

Answer 20

It stays the same

Question 21

What happens to side effect risk as doses of Diuretics, Ca2+ blockers and ß-Blockers are increased?

Answer 21

It increases

Question 22

What are some common causes of resistant hypertension?

Answer 22

Non-concardance
White coat effect
Pseudo-hypertension
Lifestyle factors
Drug interactions
2º hypertension
True resistance