Hypertension

Question 1

What is Primary Hypertension

Answer 1

Hypertension with no identifiable cause (90% of hypertension patients)

Question 2

What are the risk factors of Primary Hypertension

Answer 2

Age
Smoking
Genetics/family history
Obesity
Alcohol intake
Salt intake

Question 3

What is Secondary Hypertension

Answer 3

Hypertension caused by an identifiable singular cause that when removed brings down the BP to normal

Question 4

What can be causes for secondary Hypertension

Answer 4

Renal disease
Endocrine - adrenal gland hyper function/tumours, aldosteronism, Cushing’s, pheochromocytoma
Coarction of aorta
Drugs
Pregnancy

Question 5

What are the subtypes of hypertension

Answer 5

Benign Hypertension
Malignant Hypertension
White Coat Hypertension

Question 6

What is Benign hypertension

Answer 6

Stable elevated BP over many years
Asymptomatic

Question 7

What are the consequences of Benign Hypertension

Answer 7

LV Hypertrophy (thickening of the wall of the Left ventricular heart chamber)
Congestive cardiac failure
Increased Atheroma
Thickening of Tunica Media
Aneurysm rupture
Renal Disease

Question 8

What is Malignant Hypertension

Answer 8

Acute severe elevation of BP - diastolic pressure >130-140 mmHg

Question 9

What can Malignant Hypertension develop from

Answer 9

Benign primary or secondary hypertension or from nothing

Question 10

What can Malignant Hypertension lead to

Answer 10

Needs urgent treatment to prevent death:
Cerebral oedema
Acute renal and heart failure
Haemorrhage

Question 11

What is White Coat Hypertension

Answer 11

Hypertension that only exists when BP is measured during medical consultations
Difference of more than 20/10 mmHg between clinical and average daytime ABPM

Question 12

What is Stage 1 Hypertension

Answer 12

Clinical BP 140/90 mmHg or higher
ABPM or HBPM daytime average 135/85 or higher

Question 13

What is Stage 2 Hypertension

Answer 13

Clinical BP 160/100 mmHg or higher
ABPM or HBPM daytime average is 150/95 mmHg

Question 14

What is severe Hypertension

Answer 14

Clinical systolic BP is 180 mmHg or higher or
Clinical Diastolic BP is 110 mmHg or higher

Question 15

What are symptoms of Malignant hypertension

Answer 15

Headache
Blurred vision
Chest pain
Altered mental status

Question 16

When would you use ABPM and HBPM

Answer 16

ABPM if clinical BP>140/90 mmHg
HBPM if ABPM declined/not tolerated

Question 17

How do you monitor for end organ damage

Answer 17

Urine - Haematuria (blood in urine), Alb:Cr ratio
Bloods - FBC (full blood count), U+Es (Urea and Electrolytes), Glucose, fasting lipids, electrolytes
Fundoscopy - hypertensive retinopathy
12 lead ECG
Calculate 10 year CV risk

Question 18

How is stage 1 hypertension usually managed

Answer 18

Lifestyle intervention alone

Question 19

What is step 1 of medical management in <=55 year olds

Answer 19

ACE-inhibitor (e.g. ramipril)
If unable to tolerate ACE-inhibitor switch to ARB (e.g. candesartan)

Question 20

What is step 1 of medical management in >55 year olds or African or Caribbean ethnicity

Answer 20

DHP-Calcium channel Blocker (e.g. nefedipine)

Question 21

What is step 2 of medical management

Answer 21

If maximal does of step 1 has failed or not tolerated:
Combine CCB and ACE-i/ARB

Question 22

What is step 3 of medical management

Answer 22

If maximal does of step 2 has failed or not tolerated:
Add thiazide-like diuretic (e.g. indapamide)

Question 23

What is step 4 of medical management if blood potassium is <4.5 mmol/L

Answer 23

Add spironolactone

Question 24

What is step 4 of medical management if blood potassium is >4.5 mmol/L

Answer 24

Increase thiazide-like diuretic dose
Add alpha blocker (e.g. doxacosin)
Add beta blocker (e.g. atenolol)
Referral to cardiology for further advice

Question 25

When would you give Statins

Answer 25

If 10-year CV risk is >20%

Question 26

What is the BP target for <80 years

Answer 26

Clinic BP <140/90 mmHg
<135/85 AMPM/HBPM

Question 27

What is the BP target for >80 years

Answer 27

Clinic BP <150/90 mmHg
<145/85 AMPM/HBPM

Question 28

What is the BP target for Diabetics

Answer 28

Clinic BP <130/80 mmHg