Hypertension

Question 1

What are the stages of HTN?

Answer 1

Stage 1
- Clinic BP >140/90
- ABPM >135/85

Stage 2
- Clinic BP >160/100
- ABPM >150/95

Severe HTN
- BP >180/120
- Accelerate HTN- stage 3 and retinal haemorrhage/papilloedema- admit

Question 2

What is the initial management of severe HTN?

Answer 2

Admit if accelerated or signs of HTN emergency
Consider investigating for phaeochromocytoma
If no indication for admission- urgent investigations
- Bloods
- ACR
- ECG
- if signs of organ damage- treat immediately
- no no organ damage repeat BP in clinic in 7 days

Question 3

What is the outline of management for HTN?

Answer 3

Stage 1
- If <80 start treatment if any of following present
1) Evidence of end organ damage
2) CVD or QRISK >10%
3) Comorbidities e.g. CKD or diabetes
- consider if <60 and QRISK <60 or >80 and BP >150/90

Stage 2
- offer treatment

Question 4

What are the target BPs?

Answer 4

Age <80
- Target BP 140/90

Age >80 add 10

If diabetic or CKD aim <130/80

Question 5

What is the stepwise management in people <55 or diabetic?

Answer 5

1) ACEi- ARB if not tolerated
2) Continue ACEi or ARB add CCB or thiazide
3) ACEI + CCB + thiazide
4) If K <4.5 then spironolactone
If K >4.5 then alpha/beta blocker
5) Refer to specialist

Question 6

What is the stepwise management in people >55 or african caribbean?

Answer 6

1) CCB
2) CCB and ACEi or Thiazide
3) ACEi + CCB + Thiazide
4) If K <4.5 then spironolactone
If K >4.5 then alpha/beta blocker
5) Refer to specialist