Hypertension

Question 1

Types HTN

Answer 1

Essential/Primary HTN:
High BP with unrelated cause.

Secondary HTN:
HTN with Kidney or endocrine disease/caused by another medical condition.

Resistant HTN:
High BP that doesn’t respond well to aggressive medical treatment. Uncontrolled BP after 3 or more hypertensive treatments

Question 2

Signs and symptoms (HTN)

Answer 2

Often no symptoms but when BP is extremely high they can show:
Fatigue or confusion
Vision problems
Chest pain
Difficulty breathing
Irregular heartbeat
Blood in the urine
Pounding in chest, neck or ears

Question 3

Treatment (HTN)

Answer 3

NON DRUG:
Regular exercise,
Healthy diet (2/3 portion of fish/week, lean meat, reduce fatty foods [cheese, fatty meats, fried food, butter])
Reduce salt and sodium intake,
Reduce alcohol

CHECK DIAGRAM
KEY:
HTN with T2DM - 1st line ACEi/ARB
HTN <55 & NOT black African/ African- Caribbean family origin - 1st line ACEi/ARB
HTN 55+/Black African/ African- Caribbean family origin - 1st line CCB

Question 4

BP Targets

Answer 4

IDEAL RANGE:
90/60 - 120/80.

Clinical BP
Age <80 - 140/90
Age >80 - 150/90

ABPM
Average BP <80 - 135/85
>80 - 145/85

Question 5

Pre-Eclampsia/ Pregnancy with HTN

Answer 5

Pre eclampsia - Mainly happens after 20 weeks pregnancy with features of multi organ involvement or soon after birth and is high BP with Pregnancy.
Usually >140/90 and large amounts of protein in urine.

Chronic HTN- HTN b4 pregnancy or found in first 20 weeks pregnancy.

Gestational HTN - New onset HTN after 20 week pregnancy.

Signs/Symptoms:
Severe headache,
Problems with vision,
Severe pain below ribs,
Vomiting and
Sudden swelling of hands, feet or face accompanied with significant proteinuria and BP>140/90.

URGENT REFER to hospital if >160/110

More risk of pre eclampsia if: DM, CKD, autoimmune disease, chronic HTN, previous HTN in pregnancy.
PREVENTION:
- Advised to take aspirin FROM 12 week till baby is born.
If women has >1 risk factor for pre eclampsia (1st pregnancy, >40yrs old, Pregnancy with interval of 10 yrs, BMI>35, multiple pregnancy, Family Hx of Pre eclampsia):
- Advised with aspirin as above.

Female with chronic HTN STOP: ACEi, ARBs, thiazide or thiazide-like diuretics due to an increased risk of congenital abnormalities.

Treatment (Pre eclampsia, gestational or chronic HTN [pregnancy])
BP 140/90 or +:
1st line - Oral Labetalol to get BP <135/85. ALT nifedipine MR ALT methyldopa.
BP>160/110:
1st line IV Labetalol, OR IV hydralazine OR oral nifedipine MR

POST BIRTH:
If on Methyldopa should STOP 2 days after birth and switch.

Breastfeed
1st line enalapril (monitor renal function/serum K+). BUT for black African/African-Caribbean family origin - 1st line - Nifedipine or Amlodipine.
If BP not controlled combine Nifedipine/Amlodipine with enalapril.
FAIL - ADD Labetalol or Atenolol or switch 1.

Question 6

HTN in renal disease

Answer 6

People with CKD stage 3 or + or micro/macro albuminuria or people on dialysis OFFER BP lowering treatment.

TARGET BP 140/90. ACR target <70mg/mmol.

Try keep drugs once daily.

ACEi/ARB mainly used in CKD for BP lowering - NICE

Question 7

Hypertensive emergency

Answer 7

BP with reading 180/120 or +.

Symptoms in emergency:
Severe headaches/vomiting
Severe anxiety
SOB
Nosebleeds
Retinal haemorrhage

If BP is 180/110 with no acute target organ damage its hypertensive urgency and not emergency.

REQUIRE REFERAL TO HOSPITAL