Hypertension

Question 1

What is hypertension?

Answer 1

Persistently raised arterial blood pressure

Can be primary or secondary

Has 3 stages

Question 2

What are the 3 stages of hypertension?

Answer 2

Stage 1 - clinical BP from 140/90 to 159/99 mmHg or average at home BP from 135/85 to 149/94 mmHg

Stage 2 - clinical BP from 160/100mmHg+ but less than 180/120mmHg or average at home reading of 150/95mmHg +

Stage 3 (severe) - clinical systolic of 180mmHg or higher OR clinical diastolic of 120mmHg or higher

Question 3

What is malignant hypertension?

Answer 3

severe increase in blood pressure to 180/120 mmHg or higher (and often over 220/120 mmHg)

with signs of retinal haemorrhage and/or papilloedema

is usually associated with new or progressive target organ damage

Question 4

What are some risk factors for hypertension?

Answer 4

Age

Gender - women lower except ages 65-74

Ethnicity - Black African or Caribbean

Genetics - FHx

Social deprivation

Co-existing diabetes or kidney disease

Lifestyle - smoking, alc, excess salt, obesity, lack of exercise

Anxiety and emotional stress- due to raised adrenaline and cortisol

Question 5

What are some secondary causes of hypertension?

Answer 5

Renal disorders - CKD, PCKD, RCC etc

Vascular disorders- coarctation of aorta, renal artery stenosis

Endocrine disorders- primary hyperaldosteronism, Phaeochromocytoma, Cushing’s syndrome, acromegaly, hyperthyroidism

Drugs and other substances - alcohol, cocaine, corticosteroids, nsaids etc

Pregnancy

Obstructive sleep apnoea

Question 6

How is hypertension diagnosed?

Answer 6

Measure BP in clinic- both arms
If raised, repeat

If the person’s blood pressure is between 140/90 mmHg and 180/120 mmHg, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension

Or HBPM - takes BP twice daily for a week

Question 7

When should you refer to specialists?

Answer 7

If the person’s blood pressure is 180/120 mmHg or higher

Investigate for target organ damage

Question 8

What conditions does HTN increase the risk of?

Answer 8

Heart failure.
Coronary artery disease.
Stroke.
Chronic kidney disease.
Peripheral arterial disease.
Vascular dementia.

Question 9

What else should be investigated when diagnosing HTN?

Answer 9

Organ damage:
-Haematuria
-Urine ACR
-HbA1c
-eGFR
-Examine fundi
-ECG

CVD risk:
-Cholesterol and HDL
-QRISK

Question 10

How is HTN managed?

Answer 10

Step 1 - ACEi or ARB (under 55, T2DM, ARB is preferred for Afro-Caribbean)
OR CCB (55yrs<, Afro-Caribbean)
Add thiazide like diuretic if oedema present

Step 2 - ACEi/ARB + CCB or thiazide like diuretic

Step 3 - ACEi + CCB + thiazide like diuretic

Step 4 - resistant hypertension, consider low dose spironolactone or alpha or beta blocker

Question 11

What are the target BP levels for people receiving treatment?

Answer 11

Adults aged under 80 years — clinic blood pressure below 140/90 mmHg.

Adults aged 80 years and over — clinic blood pressure below 150/90 mmHg

Adults aged under 80 years — HBPM below 135/85 mmHg.

Adults aged 80 years and over — HBPM below 145/85 mmHg.

Question 12

What follow up should HTN patients get?

Answer 12

Annual review
Measure BP
Reassess meds
Check compliance etc
Report any symptoms or side effects