Hypertension

Question 1

What conditions is high blood pressure a risk factor for?

Answer 1

stroke
MI
heart failure
chronic kidney disease
cognitive decline
premature death

Question 2

Stage 1 hypertension definition

Answer 2

clinic BP >140/90 AND ABPM/HBPM average >135/85

Question 3

Stage 2 hypertension definition

Answer 3

clinic BP >160/100 AND ABPM/HBPM average >150/95

Question 4

Stage 3 hypertension definition

Answer 4

clinic BP >180 systolic OR clinic BP >120 diastolic

Question 5

Describe the white coat effect

Answer 5

a discrepancy of more than 20/10 mmHg between clinic and average daytime ABPM or average HBPM measurements at the time of diagnosis

Question 6

Risk factors for coronary artery disease (clear link and modifiable, clear link non-modifiable, link less clear modifiable)

Answer 6

clear link and modifiable:
- smoking
- hypertension
- high cholesterol
- diabetes

clear link non-modifiable:
- age
- gender
- family history
- ethnicity

link less clear modifiable:
- obesity
- poor diet
- physical inactivity
- stress

Question 7

What tool is used to calculate cardiovascular risk?

Answer 7

QRISK2

Question 8

What organs can be damaged with hypertension? (end organ damage)

Answer 8

eye
brain
kidneys
heart

Question 9

Retinal changes in hypertension

Answer 9

hard exudates
cotton wool spots
flame haemorrhages

Question 10

What is the calculation to work out if left ventricular hypertrophy is present?

Answer 10

S wave depth in V1 + tallest R wave height in V5-V6 >35mm

Question 11

Left ventricular hypertrophy ECG changes

Answer 11

left atrial enlargement
left axis deviation
lateral ST segment depression with T wave flattening or inversion (‘strain pattern’)

Question 12

List some causes of secondary hypertension

Answer 12

renovascular disease
renal parenchymal disease
coarctation of aorta
primary aldosteronism (Conn’s syndrome)
Cushing’s disease/cortisol secreting adrenal tumour
pheochromocytoma
obstructive sleep apnoea

Question 13

General measures to lower blood pressure

Answer 13

weight reduction (each kg = 1-2 mmHg lower systolic BP)
dietary salt
alcohol
exercise
smoking

Question 14

Stage 1 hypertension management

Answer 14

offer lifestyle interventions
younger than 40 = specialist referral
target organ damage, diabetes, renal impairment, CVD, QRISK2>10% = antihypertensive drug treatment

Question 15

Stage 2 hypertension treatment

Answer 15

antihypertensive drug treatment
offer lifestyle interventions

Question 16

When is an ACE-inhibitor first line antihypertensive treatment?

Answer 16

aged <55
diabetes any age
not afro-caribbean

Question 17

When is a calcium channel blocker first line antihypertensive treatment?

Answer 17

aged >55
afro-caribbean origin any age

Question 18

Describe the antihypertensive drug pathway

Answer 18

ACE-i/ARB or CCB

ACE-i/ARB + CCB

ACE-i/ARB + CCB + thiazide-like diuretic

resistant hypertension = consider spironolactone, alpha blocker, beta blocker and seek specialist advice

Question 19

What blood pressures are the goal of antihypertensive treatment?

Answer 19

Clinic:
140/90 mmHg in people <80
150/90 mmHg in people 80+

ABPM/HBPM:
below 135/85 mmHg in people <80
below 145/85 mmHg in people 80+