Hypertension

Question 1

What are risk factors for hypertension?

Answer 1

Age
Smoking
Genetics/Family history
Obesity/Obstructive sleep apnoea
Raised alcohol intake
Raised salt intake

Question 2

What is secondary hypertension?

Answer 2

This form has an identifiable cause, with removal/reversal of this returning BP to a normal level.

Question 3

What are causes of secondary hypertension?

Answer 3

Renal disease (most common)

Endocrine (adrenal tumours/hyperfunction, aldosteronism, Cushing’s syndrome/disease or phaeochromocytoma)

Coarctation of the aorta

Drugs (e.g. corticosteroids)

Pregnancy (pre-eclampsia/eclampsia)

Question 4

What is malignant hypertension?

Answer 4

An acute, severe elevation of BP, with diastolic of 130-140mmHg.

Requires urgent management to prevent death (will lead to cerebral oedema, acute renal and heart failure, and haemorrhage).

Question 5

What is white-coat hypertension?

Answer 5

Hypertension which only exists when BP is measured as part of a medical consultation.

Question 6

What is classified as stage 1 hypertension?

Answer 6

In-clinic BP of 140/90mmHg or higher, AND an ambulatory BP of 135/85mmHg or higher.

Question 7

What is classified as stage 2 hypertension?

Answer 7

In-clinic BP of 160/100mmHg or higher, AND a daytime average of 150/95mmHg or higher.

Question 8

What is classified as severity hypertension?

Answer 8

A clinical BP of 180mmHg or higher, or a clinical BP of 110mmHg or higher.

Question 9

What symptoms does hypertension usually present?

Answer 9

Usually asymptomatic - an incidental finding.

Question 10

How does malignant hypertension present?

Answer 10

Will have acute symptoms - headache, blurred vision, N+V,, chest pain and altered mental status.

Question 11

What is the initial management of hypertension in an individual below 55 years of age?

Answer 11

ACE inhibitor

If cannot tolerate this, give ARB.

Question 12

What is the initial management of hypertension in an individual above 55 years of age OR of Afro-Caribbean ethnicity?

Answer 12

CCBs

Important to note that this is given in those of Afro-Caribbean ethnicity of ANY age.

Question 13

Following step 1 therapy for hypertension, what is given?

Answer 13

Combine CCB and ACE inhibitor/ARB therapy.

Then, if unsuccessful or intolerable, give a thiazide-like diuretic.

Question 14

What is fourth-line hypertension treatment?

Answer 14

If blood potassium is <4.5mmol/L, add spironolactone.

Although, if >4.5mmol/L, give a thiazide-like diuretic. Alternatively, these patients may be given alpha-blockers or beta-blockers. Likely best to refer to cardiology for further advice.

Question 15

What are the causes of hypertension?

Answer 15

Heart failure
Stroke
Myocardial infarction
Encephalopathy