Hypertension

Question 1

Who should be treated for hypertension?

Answer 1

ALL with BP >160/100
or ABPM >150/90

Tx if BP >140/90 if:
- increased cardiac risk
- T2DM
- end organ damage

Question 2

What percentage of patients have Primary or “essential” hypertension vs Secondary Hypertension?

Answer 2

Primary 95%
Secondary 5%

Question 3

Causes of Secondary Hypertension

Answer 3

Renal disease:
75% Intrinsic renal disease - glomerulonephritis/Polycystic kidneys
25% Renovascular disease

Endocrine conditions:
Cushing’s
Conn’s
Phaeochromocytoma
Acromegaly
Hyperparathyroid

Other:
Coarctation of aorta
Pregnancy
Drugs (steroids, Contraceptive Pill)

Question 4

What is malignant hypertension?

Answer 4

Rapid BP rise causing vascular damage
Systolic >200, diastolic >130

Question 5

Symptoms/Signs of malignant hypertension

Answer 5

Headache
Visual disturbance
Bilateral retinal haemorrhages/exudates +/- papilloedema

Question 6

Malignant Hypertension is more common in what demographics?

Answer 6

Black patients
Younger patients

Question 7

Malignant Hypertension may precipitate hypertensive EMERGENCIES. What are these?

Answer 7

AKI
heart failure
encephalopathy + seizures

Question 8

Important Ix in Hypertension

Answer 8

ABPM
Fasting glucose
Cholesterol + Lipids
ECG
ECHO
Urinalysis for blood/protein
Renal US/angio
24hr urinary metanephrines
urinary free cortisol
MR Aorta is suspecting coarctation

Question 9

Lifestyle Mx of hypertension

Answer 9

Stop smoking
reduced salt and low fat diet
reduced alcohol
Increased exercise
Lose weight if overweight/obese

Question 10

What drugs used to treat hypertension can increase the risk of diabetes?

Answer 10

Beta-blockers
Thiazide diuretics

Question 11

What pharmacological treatments can be used to manage hypertension?

Answer 11

1. ACEi/ARB - first line
2. Ca2+ channel blocker - (first line in patients >45 years or black/ Afro-caribbean)
3. Thiazide Diuretic
4. Spironolactone/Beta Blocker

Question 12

Side effects of common hypertension treatments

Answer 12

ACEi/ARB - dry cough

Ca2+ channel blocker - ankle swelling

Thiazide - Low K+/Na+, poor diabetic control

Spironolactone - high K+

Beta blocker - bronchospasm, diabetes, heart failure

Question 13

Tx of malignant hypertension

Answer 13

IV labetalol 50mg over 1 minute
repeat every 5 mins (up to 200mg)

Useful to have arterial line to measure accurate BP