Hypertension

Question 1

What is normal blood pressure range?

Answer 1

90/60mmHg to 140/90mmHg

Question 2

Define hypertension?

Answer 2

A 24h ambulatory blood pressure average reading (ABPM) that is more than or equal to 135/85mmHg.

Question 3

Why does hypertension occur?

Answer 3

Due to:
- reduced elasticity of large arteries
- age-related
- atherosclerosis-related calcification
- degradation of arterial elastin.

May present in conditions associated with increased cardiac output -e.g. anaemia, hyperthyroidism, aortic regurgitation.

Question 4

How is hypertension classified?

Answer 4

Based on how high the pt’s BP is.

Stage 1:
Clinic = 140/90mmHg
ABPM = 135/85mmHg

Stage 2:
Clinic = 160/100mmHg
ABPM =150/95mmHg

Stage 3:
Clinic systolic BP = 180
OR
Diastolic BP =120mmHg

Question 5

Presentation of hypertension?

Answer 5

Asymptomatic unless malignant HTN.

Question 6

How is hypertension diagnosed?

Answer 6

ABPM or HBPM (1ST LINE)

Assess end-organ damage:
- Urine dip
- Albumin:creatinine level
- Bloods: glucose, lipids, U&Es
- Fundoscopy (retinopathy)
- ECG (LV hypertrophy)

Same day specialist assessment:
- if clinical BP ≥180/120mmHg
- signs of retinal haemorrhage or papilloedema (accelerate HTN)
- signs of life-threatening symptoms (new onset confusion, chest pain, heart failure signs or AKI)

Question 7

Management of hypertension?

Answer 7

Conservative:
- Weight loss
- Healthy diet (reduce salt and saturated fats)
- Reduce alcohol and caffeine
- Reduce stress
- Stop smoking

Medical:
- start meds for stage 1 HTN who are <80years with end organ damage, CVD, renal disease, diabetes, or QRISK >10%
- start meds for anyone with stage 2 HTN

HTN + Type 2 diabetes OR age <55years
1) ACEi/ARB
2) + CCB or THIAZIDE
3) ACEi/ARB + CCB + THIAZIDE
4) + low-dose spironolactone if potassium ≤4.5 mmol/l OR alpha/beta-blocker if potassium >4.5 mmol/l

HTN + no diabetes
1) CCB
2) + ACEi/ARB or THIAZIDE
3) ACEi/ARB + CCB + THIAZIDE
4) + low-dose spironolactone if potassium ≤4.5 mmol/l OR alpha/beta-blocker if potassium >4.5 mmol/l

ABPM targets:
Age <80 years: <135/85
Age >80 years: <145/85 (due to risk of postural drop and falls)
T1DM with end-organ damage: <130/80

Question 8

Complications of hypertension?

Answer 8

Increased risk of morbidity and mortality from all causes
Coronary artery disease
Heart failure
Renal failure
Stroke
Peripheral vascular disease

Question 9

Examples of thiazide-like diuretic?

Answer 9

Indapamide

Question 10

Example of alpha blocker?

Answer 10

Doxazosin

Question 11

Example of beta blocker?

Answer 11

Atenolol

Question 12

Example of CCB?

Answer 12

Amlodipine