HYPERTENSION

Question 1

Normal BP

Answer 1

120/80 mmHG

Question 2

Stage 1 Hypertension

Answer 2

• Clinic BP: 140/90 -160/100mmHg
• АВРМ/НВРМ average BP:135/85 - 150/95mmHg

Question 3

When would you offer antihypertensives?

Answer 3

• <80 with kidney disease, diabetes, CVD or 10% risk of CVD in 10 years/ with blood pressure over 150/90mmH
• Drug treatment + lifestyle advice in patients <60 with < 10% risk of CVD in 10 years

Question 4

What if the patient is over 80 years old and has stage 1 hypertension?

Answer 4

if over 150/90mmHg then offer antihypertensive

Question 5

What is stage 2 hypertension?

Answer 5

• Clinic BP: 160/100 -
  180/120mmHg
• ABPM/НВРМ average
  BP: 150/95 mmHg or higher

Question 6

How do you treat
stage 2 hypertension?

Answer 6

• Offer Antihypertensives (as well as lifestyle advice)
• Regardless of age

Question 7

What is stage 3 hypertension?

Answer 7

> 180/120mmHg
Medical emergency

Question 8

What is the target clinical blood pressure?

Answer 8

• Below 80 = <140/90
• Over 80 = <150/90, abpm <45/85

Question 9

Hypertension with T2DM

Answer 9

1. ACEi or ARB
2. ACEi or ARB + CCB or thiazide-like diuretic
3. ACEi or ARB + CCB + thiazide like diuretics

Question 10

Hypertension without T2DM. Age < 55 and not black

Answer 10

1. ACEi or ARB
2. ACEi or ARB + CCB or thiazide-like diuretic
3. ACEi or ARB + CCB + thiazide like diuretics

Question 11

Hypertension without T2DM. Age 55+

Answer 11

1. CCB
2. CCB + ACEi or ARB or thiazide-like diuretic
3. ACEi or ARB + CCB + thiazide-like diuretic

Question 12

Hypertension without T2DM
Black

Answer 12

1. CCB
2. CCB + ACEi or ARB or thiazide-like diuretic
3. ACEi or ARB + CCB + thiazide-like diuretic

Question 13

Step 4

Answer 13

Consider:
- Low dose Spironolactone (unlicensed) if serum K+ <4.5mmol/L
- Alpha-blocker/ beta blocker
if serum K+ >4.5mmol/L

Question 14

Can ACEi and ARB be combined?

Answer 14

YOU SHOULD NOT COMBINE THE BOTH TO TREAT HYPERTENSION

Question 15

Renal disease BP

Answer 15

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