Hypertension

Question 1

What are the risk factors for primary HTN?

Answer 1

• Positive family history (Genetics)
• Overweight/obesity
• Alcohol excess
• Excess dietary salt

Question 2

Identify the secondary causes of HTN.

Answer 2

• Renal (e.g. diabetic nephropathy)
• Renovascular (renal artery stenosis)
• Endocrine (e.g. Primary hyperaldosteronism, phaeochromocytoma, hyperthyroidism)
• Coarctation of the aorta
• Pregnancy-induced
• Exogenous hormones (e.g. oestrogen in the Combined oral contraceptive pill)

Question 3

How do we diagnose and investigate hypertension? PART 1

Answer 3

If BP in clinic is 140/90mmHg or higher:
- Take a second measurement during consultation
- If substantially different from the first, take a third measurement.
- Record the lower of the last two measurements as the clinic BP

Question 4

How do we diagnose and investigate hypertension? PART 2

Answer 4

If the clinic BP is 140/90mmHg or higher:
- Offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension.
- If a person is unable to tolerate ABPM, offer home blood pressure monitoring (HBPM)

Question 5

How do we diagnose and investigate hypertension? PART 3

Answer 5

If the person has severe hypertension (systolic BP ≥180 mmHg and/or diastolic BP ≥120 mmHg:
- Consider starting antihypertensive drug treatment immediately, without waiting for the results of ABPM or HBPM

Question 6

What factors would support a hypertension diagnosis?

Answer 6

• Clinic blood pressure of 140/90 mmHg or higher
• ABPM daytime average or HBPM average of 135/85 mmHg or higher

Question 7

How would someone tell the difference between Stage 1 and Stage 2 HTN?

Answer 7

Stage 1 Hypertension:
- Clinic BP ≥140/90 but ≤ 159/99 mm Hg (ABPM/HBPM daytime average ≥135/85 but ≤ 154/94 mm Hg)

Stage 2 Hypertension
- Clinic BP ≥160/100 mm Hg (ABPM/HBPM daytime average ≥155/95 mm Hg)

Question 8

How would HTN be investigated?

Answer 8

• PART 1 - Targeted organ damage - Plasma U&Es, ECG
• PART 2 - Test for secondary causes - MR renal angiogram, test plasma renin/aldosterone levels

Question 9

How could HTN be treated?

Answer 9

• Lifestyle interventions
• Treat secondary causes e.g surgery for adrenal tumours
• Cardiovascular risk assessment
• Antihypertensive drugs (dependent on age, ethnicity, tolerability)

Question 10

Describe the ABCD approach to antihypertensive prescription.

Answer 10

• ACE inhibitors or Angiotensin receptor blockers (e.g. Ramipril, Losartan)
• Beta blockers (e.g. Atenolol)
• Calcium Channel Blockers (e.g. amlodipine)
• Diuretics (e.g. Indapamide)

Question 11

How would a doctor choose drugs for patients newly diagnosed with HTN?

Answer 11

SEE SLIDES

Question 12

How can patients with HTN be monitored?

Answer 12

• Regular BP checks and add in treatment in step-wise fashion to get to target clinic blood pressure of <140/90 mm Hg (home target of <135/85 mm Hg)
• Monitor for adverse effects and tolerability of treatment