Hypertension

Question 1

Stage 1 HTN clinic BP readings

Answer 1

140/90 - 159/99mmHg

Question 2

Stage 1 HTN ambulatory BP readings

Answer 2

135/85-149/94mmHg

Question 3

Which patients with stage 1 HTN BP reading should you start treatment?

Answer 3

Patients >80 with BP over 150/90mmHg

Question 4

Which patients with a stage 1 HTN BP reading should you offer lifestyle advice and only consider drug treatment?

Answer 4

Patients <60 with <10% risk of CVD in 10 years

Question 5

Which patients with a stage 1 HTN BP reading should you offer lifestyle advice and discuss starting treatment with?

Answer 5

Patients <80 with comorbidities of kidney disease, diabetes, CVD or 10% risk of CVD in next 10 years

Question 6

Stage 2 HTN clinic BP readings

Answer 6

160/100 - 180/120mmHg

Question 7

Stage 2 HTN ambulatory BP readings

Answer 7

> 150/95mmHg

Question 8

Which patients should you start treatment immediately if they have a stage 2 HTN BP reading

Answer 8

All

Question 9

Stage 3 HTN BP readings

Answer 9

> 180/120mmHg
Hypertensive crisis

Question 10

How to manage stage 3 HTN?

Answer 10

Medical emergency

Question 11

Step 1 antihypertensive treatment in patients <55 years old / patients with diabetes

Answer 11

ACE-I or ARB

Question 12

Step 2 antihypertensive treatment in patients <55 years old / patients with diabetes

Answer 12

ACE-I / ARB + CCB or TLD

Question 13

Step 3 antihypertensive treatment

Answer 13

ACE-I / ARB + CCB + TLD

Question 14

Step 4 antihypertensive treatment if potassium <4.5mmol/l

Answer 14

Low dose spironolactone

Question 15

Step 4 antihypertensive treatment if potassium >4.5mmol/l

Answer 15

Alpha or beta blocker

Question 16

Choice of antihypertensive if T2DM and Afro-carribean?

Answer 16

ARB

Question 17

Step 1 antihypertensive treatment for >55 years old or Afro-Caribbean patients

Answer 17

CCB

Question 18

Step 2 antihypertensive treatment for >55 years old or Afro-Caribbean patients

Answer 18

CCB + ACE-I/ARB

Question 19

Clinic BP target for patients <80 years old with T1DM if urine albumin:creatinine ratio <70mmHg

Answer 19

140/90mmHg

Question 20

Clinic BP target for patients <80 years old with T1DM if urine albumin:creatinine ratio >70mmHg

Answer 20

<130/80mmHg

Question 21

Clinic BP target for patients >80 years old with T1DM

Answer 21

150/90mmHg regardless of urine albumin:creatinine ratio

Question 22

Clinic BP target for patients with renal disease

Answer 22

140/90mmHg and want albumin:creatinine ratio of <70mg/mmol

Question 23

Clinic BP target for patients with T2DM

Answer 23

Same thresholds and treatment targets used with or without T2DM

Question 24

Clinic BP target for pregnant women

Answer 24

<135/85mmHg

Question 25

Which complication can occur if HTN is untreated during pregnancy?

Answer 25

Pre-eclampsia

Question 26

Treatment of pre-eclampsia

Answer 26

Aspirin from week 12 of pregnancy until birth

Question 27

Treatment of HTN in pregnant women

Answer 27

1st: Labetalol
2nd: Nifedipine or methyldopa

Question 28

When should methyldopa be discontinued if used to treat HTN in pregnant women?

Answer 28

2 days before birth

Question 29

Treatment of HTN for a breastfeeding woman?

Answer 29

Enalapril

Question 30

Treatment of HTN for a breastfeeding black or Afro-Caribbean woman?

Answer 30

1st: Combination of nifedipine or amlodipine with enalapril
2nd: Labetalol or atenolol

Question 31

Which patients should you measure standing and sitting BP in?

Answer 31

T2DM
Symptoms of postural hypotension
>80 years

Question 32

How often should patients with a BP <140/90mmHg measure their BP?

Answer 32

Every 5 years

Question 33

What should the target BP be based on for a patient with postural hypotension?

Answer 33

Standing BP

Question 34

BP target for <80 years old

Answer 34

<140/90mmHg (clinic)
<135/85 (ambulatory)

Question 35

BP target for >80 years old

Answer 35

<150/90mmHg (clinic)
<145/85mmHg (ambulatory)