HYPERTENSION

Question 1

Stage 1 hypertension

Answer 1

140/90 - 159/99mmHg (clinic) or 135/85 - 149/94 mmHg (ambulatory)
Drug treatment in patients <80 with kidney disease, diabetes, CVD or 10% risk of CVD in 10 years
Drug treatment + lifestyle advice in patients <60 with < 10% risk of CVD in 10 years
Drug treatment in patients > 80 with blood pressure over 150/90mmH

Question 2

Stage 2 hypertension

Answer 2

160/100 - 180/120mmHg (clinic) or >150/95mmg (ambulatory)
Treat all patients

Question 3

Stage 3 hypertension

Answer 3

> 180/120mmHg
Medical emergency

Question 4

Step 1 - <55/ T2DM

Answer 4

ACEi or ARB
If CI/not tolerated = B-blocker

Question 5

Step 1 - >55 OR afro-caribbean)

Answer 5

CCB
If high risk of heart failure or CCB not tolerated/CI = TLD

Question 6

Step 2 - <55/ T2DM

Answer 6

Add CCB
If high risk of heart failure or CCB not tolerated/CI = TLD

Question 7

Step 2 - >55 OR afro-caribbean)

Answer 7

Add ACEi/ARB
ARB preferred in afro-caribbean patients.

Question 8

Step 3

Answer 8

ACEi/ARB + CCB + TLD

Question 9

Step 4 (resistant hypertension)

Answer 9

if K = less than 4.5mmol/l = low dose spironolactone
OR
if K = more than 4.5mmol/l =
- High dose TLD if CI/Ineffective add Alpha or Beta-blocker.

Question 10

Normal BP

Answer 10

120/80 mmHG

Question 11

<80 years BP

Answer 11

<140/90 mmHG
130/80 in atherosclerotic CVD or diabetes with kidney, eye or cerebrovascular disease.

Question 12

80+ years BP

Answer 12

<150/90

Question 13

Renal disease BP

Answer 13

<140/90 mmHG
130/80 if:
- CKD
- Diabetes
- Proteinuria >1g in 24 hours (consider ACEi/ARB if proteinuria present)

Question 14

Diabetic BP

Answer 14

<140/90
<130/80 if complications; eye, kidney or cerebrovascular disease.

Question 15

Patients are at high risk of developing pre-eclampsia in

Answer 15

Kidney Disease, Diabetes, Autoimmune Disease, Hypertension

Take Aspirin from week 12 of pregnancy till birth

Question 16

Pregnant BP

Answer 16

<150/100 chronic hypertension
<140/90 chronic hypertension (in patients with complications e.g. target organ damage or given birth)

Question 17

Management of hypertension in pregnancy

Answer 17

If patient has blood pressure greater than 140/90mmHg
1st Line: Labetalol
2nd Line: Nifedipine or Methyldopa
Aim for blood pressure of 135/85mmHg

Question 18

Hypertension - Targets

Answer 18

Aged <80: 140/90 mmHg (clinical)
Aged <80: 135/85 mmHg (ambulatory)
Aged >80: 150/90 mmHg (clinical)
Aged >80: 145/85 mmHg (ambulatory)
Renal Disease: 140/90 mmHg (clinical)
Pregnancy: 135/85mmHg (clinical)
Type 1 Diabetes: 135/85mmHg (clinical)

Question 19

ambulatory vs clinical

Answer 19

ambulatory is usually 5 less