Hypertension

Question 1

How is hypertension diagnosed?

Answer 1

blood pressure >140/90 in a clinical setting confirmed with home readings of >135/85

Question 2

What causes hypertension?

Answer 2

renal disease - most common cause
obesity
pregnancy induced hypertension or preeclampsia
endocrine - hyperaldosteronism (Conn’s)
drugs - alcohol, steroids, NSAIds, oestrogen and liquorice

Question 3

What may be the cause of very high blood pressure that does not respond to treatment? How can you diagnose this?

Answer 3

renal artery stenosis
diagnosed with duplex ultrasound, MRI or CT angiogram

Question 4

Patients with hypertension may develop left ventricular hypertrophy. What are the clinical signs of this?

Answer 4

sustained or forceful apex beat
seen on ECG
diagnosed using echocardiogram

Question 5

How do you confirm hypertension diagnosis in a patient with a clinic blood pressure >140/90 and <180/120?

Answer 5

24 hour ambulatory blood pressure readings

Question 6

What tests should all patients with a new diagnosis of hypertension get?

Answer 6

urine albumin: creatinine - for proteinuria
dipstick - microscopic Haematuria to assess for kidney damage
bloods - for HbA1c, renal function and lipids
fluids
ECG

Question 7

How is hypertension treated in a patient who is white and <55 or has type 2 diabetes?

Answer 7

1. ACE inhibitor e.g., ramipril
2. CCB e.g., amlodipine
3. thiazide like diuretic
4. add spironolactone is potassium is 4.5 of less, or an alpha blocker if it is more

Question 8

How is hypertension treated in a patient who is over 55 or black?

Answer 8

1. CCB (amlodipine)
2. thiazide like diuretic
3. ACE inhibitor / candastartan instead if black
4. spironolactone or doxazosin depending on potassium levels

Question 9

What electrolyte abnormalities can be caused by spironolactone? ACE inhibitors? thiazide diuretics?

Answer 9

spiro - hyperkalaemia
ACE inhibitors - hyperkalaemia
thiazide - hypokalaemia

Question 10

What are the blood pressure treatment targets for hypertensive patients?

Answer 10

<80 years = <140/90
>80 years = <150/90

Question 11

What defines a hypertensive emergency?

Answer 11

bp >180/120
+ retinal haemorrhages or papilloaedema

Question 12

What investigation needs to be carried out in a hypertensive emergency?

Answer 12

fundoscopy examination

Question 13

How is a hypertensive emergency treated?

Answer 13

IV treatment
- sodium nitroprusside
- labetalol
- glycerol trinitrate
- nicardipine