Hypertension

Question 1

Lowering raised Blood pressure

Answer 1

reduces the risk of stroke and coronary events,HF and renal failure

Question 2

Possible causes of hypertension

Answer 2

eg, renal and endocrine),contributory factors,risk factors and presence of complications should be established
- Patients should be given advice about lifestyle changes as they play key role in precipitating high blood pressure
○ Smoking cessation
○ Weight reduction
○ Reduce excessive alcohol and caffeine
○ Reduce dietary salt
○ Reduce total unsaturated fats
○ Increase exercise
○ Increase fruit and veg

Question 3

THRESHOLD TARGETS:

Answer 3

• Target for patients under 80=80 140/90(clinic) or 135/85(Ambulatory or home)
  
  • Patients with 140/90 mmhg blood pressure or higher should be offered measurement in ambulatory position or home BP reading to confirm diagnosis and stage of hypertension

Question 4

Stage 1:

Answer 4

• BP 140/90 or higher and ambulatory/home average 135/85 or higher
  
  • Treat Patients under 80 and target organ damage - LV hypertrophy,CKD,retinopathy,diabetes, CV disease
    Give lifestyle changes for patients under 40 with no target of organ damage

Question 5

Stage 2:

Answer 5

• Clinal blood pressure 160/100 or higher Ambulatory/home average 150/95 or higher
  
  • Treat all patients with stage 2 hypertension regardless of age

Question 6

Stage 3:

Answer 6

• Clinical BP 180/110 or higher
  
  • Treat promptly - hypertensive crisis

Question 7

TREATMENT PATHWAY - Patients UNDER 55

Answer 7

1) ACEi (enalapril,ramipril,catopril ) or Angiotensin 2 receptor blocker- candesartan,ibesartan,losartan,telmisartan (if either are not tolerated or contraindicated, consider B-blocker
2) ACEi or Angiotensin 2 receptor blockers in combo with Calcium Channel blocker - amlodipine,felodipine,nifidepine
If CCB not tolerated, give a thiazide related diuretic
If beta blocker given in step ONE, add CCB instead or diuretic
3) ACEi or AT2A in combo with CCB and thiazide like diuretic
4) Resistant hypertension

Question 8

TREATMENT PATHWAY Over 55 and patient of any age by of Afro Caribbean dissent:

Answer 8

1) Calcium channel blocker or thiazide like diuretic
2) Calcium Channel blocker+Thiazide like diuretic +ACEi or AT2a
3) ACEi or AT2A in combo with CCB and thiazide like diuretic
4) Resistant hypertension

Question 9

Hypertension with Diabetes:

Answer 9

• Targets of 140/80 or below 130/80 if kidney,eye, cerebrovascular disease present
  
  • Antihypertensive treatment prevents macro vascular and micro vascular nephropathy
  • ACEi and AT2a inhibitors can delay the progression of microalbuminuria to neuropathy
    In type 2 diabetes, hypertension indicates the presence of nephropathy usually

Question 10

Hypertension in renal disease:

Answer 10

• Targets are 140/90 or 130/80 in CKD,diabetes or if proteinuria exceeds 1g in 24 hrs