Hypertension

Question 1

HYPERTENSION

Aims:
what are the aims of treatment in hypertension?

Answer 1

Aims are to reduce the risk of cardiovascular morbidity and mortality including MI and stroke

Question 2

Treatment:
When would you initiate treatment for:
<80 yrs with stage 1
<60 yrs with stage 1

Answer 2

HYPERTENSION
<80 years: if they have target organ damage, established CVD, renal disease, diabetes or a CV risk greater than 10

<60: CV risk of 10%

(Antihypertensive drug treatment considered for >80 treatment)

Question 3

Hypertension in diabetes:
How should it be treated in these patients?

Answer 3

Agressively with lifestyle and drug treatments to reduce risk of macro/microvascular complications

Question 4

Hypertension in diabetes:
What are the BP aims for type 1 AND 2

Answer 4

if the urine albumin:creatitine ratio is less than 70mg/mol=
140/ 90

if ACR is 70mg/mmol= 150/90

Question 5

Hypertension in diabetes:
What is first line options for type 1?

What are second line options?

Answer 5

ARBs or ACEi ( RAS blocking drugs)

selective BB
Low dose thiazides may be used in combo with BB
Long acting CCB

Question 6

Hypertension in RENAL DISEASE:
What group of patients should be offered antihypertensive treatment?

Answer 6

ALL people with stage 3 or higher chronic kidney disease, micro or macroalbuminuria, on dialysis.

Question 7

Hypertension in RENAL DISEASE:
what are target clinical BP for these patients?

Answer 7

A target clinic blood pressure below 140/90 mmHg is recommended in patients with renal disease (chronic kidney disease) albumin:creatinine ratio (ACR) less than 70 mg/mmol.

130/80 mmHg= in CKD and an ACR of 70 mg/mmol or more.

ideally once daily dosing

Question 8

Hypertension in PREGNANCY:

What are the risks of high BP in pregnancy?

Define gestational diabetes

Define pre eclampsia

Answer 8

Increased risk of morbidity and mortality.

Gestational hypertension: new onset of HTN after 20 weeks gestation

Pre-eclampsia:
gestation HTN with features of multi-organ involvement

Question 9

Hypertension in PREGNANCY:
what are symptoms of pre-eclampsia?

Who are at higher risk?

what are risk factors?

what are preventative measures for these patients?

Answer 9

problems with vision, severe pain below ribs, vomiting and sudden swelling of hands, feet or face accompanied with significant proteinuria and blood pressure greater than 140/90 mmHg.

Mother has; CKD, DM, autoimmune disease, chronic hypertension or had HTN in previous pregnancy (these females are advised to take aspirin from 12 weeks until baby is born-unlicensed indication)

first pregnancy, greater than 40 years of age, pregnancy interval of greater than 10 years, BMI above 35 kg/m² at first visit, multiple pregnancy, or family history of pre-eclampsia

advised to take aspirin from 12 weeks until baby is born ( if more than one risk factor- unlicensed indication)

Question 10

Hypertension in PREGNANCY:

What is first line treatment in pre-eclampsia with BP 140/90 or higher ?

What is second line treatment?

Answer 10

Labetalol to achieve 135/85mmHg

Nifedipine MR (unlicensed)
if unsuitable —>

Methyldopa (unlicensed) this should be discontinued 2 days post birth and switched to alt

Question 11

Hypertension in PREGNANCY:
What is first line pre-eclampisa in BP >160/110 in women who require critical care?

Answer 11

Labetalol IV or hydralazine IV

Question 12

Hypertension in PREGNANCY:

what can be given to women with pre-eclampsia where early birth is likely within 7 days and why?

Answer 12

Antenatal corticosteroids for fetal lung maturation

Question 13

Hypertension in PREGNANCY:
What antihypertensive medication can be offered post birth?

Answer 13

Enalapril for breastfeeding mothers

For black women, consider Nifedipine or amlodipine

Treatment should be reviewed after 2 weeks post birth and if having treatment during pregnancy 6-8 weeks after birth with their GP or specialist.