Hypertension

Question 1

How do you diagnose hypertensive patient.

Answer 1

1. Measure blood pressure in both arms.
2. If blood pressure measured is >140/90 mmHg or higher take a second measurement and if there’s difference take 3rd one and record the lower of the last two measurement in clinic.
3. If the person’s blood pressure is between 140/90 mmHg and 180/120 mmHg:Ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension.
4. If >180/120 mmHg refer for same-day specialist and if there is life threatening symptoms: new onset confusion chest pain—> hospital.
5. If ABPM is >135/85 mmHg and clinical blood pressure is 140/90 mmHg class them in stages: stage 1 is uphill 159/99 mmHg/ Stage 2 is only up to 180/20 mmHg.

Question 2

What reading must the ABPM and clinical blood pressure be at.

Answer 2

ABPM >135/85 mmHg and clinical blood pressure is >140/90 mmHg

Question 3

How would you first manage patient that comes to your clinic who has been diagnosed with stage on hypertension. Their medical history:
Smoker 12 packs/day
Alcohol 14 units but in one night.
Receptionist.
Pre-diabetic

Answer 3

Offer lifestyle interventions:
Smoking cessation
Spread the 14 units across 5 out 7 days.
Reduce sugar content (<30%), increase fibre intake (30g-40g), increase exercise 150 minutes.
Advise walking up and down a stair.

Question 4

What is the first line agent for hypertension with patient of white descent age under 55 years.

Answer 4

ACE-inhibitors or ARBs

Question 5

What is the second line agent for hypertension with patient of white descent age under 55 years.

Answer 5

ACE-i/ ARBs + calcium channel blocker or thiazide like diuretic.

Question 6

What is the third line agent hypertension with patient of white descent age under 55 years.

Answer 6

ACEi/ARB +CCB +thiazide like diuretic.

Question 7

What is the first line agent for hypertension in black patients/patient over 55 years.

Answer 7

CCB.

Question 8

What is the second line agent for hypertension in black patients/patient over 55 years.

Answer 8

CCB + ACEi/ARBs or thiazide-like diuretic.

Question 9

What is the third line agent for hypertension in hypertension in black patients/patient over 55 years.

Answer 9

ACEI/ARBs + CCB + thiazide-like diuretic.

Question 10

What is BP targets in hypertensive patient <80 years.

Answer 10

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

Question 11

What is the BP target in hypertensive patient >80 years.

Answer 11

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

Question 12

When dose titrating what factors must you consider.

Answer 12

Postural hypotension
Frailty or multi morbidity.

Question 13

Memorise table.

Answer 13