hypertension

Question 1

What is the definition of hypertension?

Answer 1

systolic BP >140mmHg, diastolic BP >90mmHg

Question 2

What is the definition of malignant hypertension?

Answer 2

diastolic >120mmHg and exudative vasculopathy in retinal or renal circulation

Question 3

What percentage of hypertension is essential?

Answer 3

90-95%

Question 4

What are some secondary causes of hypertension?

Answer 4

1. renal e.g. renal artery stenosis 2. endocrine e.g. cushings syndrome 3. other e.g. pregnancy

Question 5

How should hypertension be confirmed?

Answer 5

elevated readings on at least 3 visits in a 2 month period

Question 6

Name some prohypertensive medications/ lifestyle factors

Answer 6

• OCP + depo contraceptives - HRT - steroids - NSAIDs - cold and flu medication - appetite suppressants - amphetamines - MAOIs - analgesics - ergotamine - cyclosporine - liquorice - alcohol (>2 standard drinks) - smoking (< 2hours before measurement) - caffeine (

Question 7

At what levels should you begin treatment for hypertension?

Answer 7

sys >140, dia >90

Question 8

What investigations should you perform in a patient with newly diagnosed hypertension?

Answer 8

fasting sugars, fasting lipids, EUC including uric acid, FBC, urinalysis, echocardiogram

Question 9

What lifestyle measures will reduce BP?

Answer 9

weight loss, decrease alcohol, decrease sodium, increase exercise, decrease stress, decrease smoking, manage sleep apnoea

Question 10

In what order are the different classes of antihypertensive medications started? What time period? should you wait before changing a dose or adding a drug

Answer 10

1. ACEI/ ARB or CCB or Low dose thiazide (if >65) 2. ACEI/ARB + CCB or ACEI/ARB + thiazide 3. ACEI/ARB + CCB + thiazide wait 4-6 weeks before changing dose or adding drug

Question 11

Describe the physiological control of BP

Answer 11

angiotensinogen——-(renin)—–angiotensin 1—- (ACE)—-Angiotensin2——-Aldosterone—– vasoconstriction and vascular remodelling

Question 12

Describe when a thiazide diuretic is recommended, contraindicated, and what the most common side effects are

Answer 12

recommended: mild heart failure, age> 65 contraindicated: DM2,kidney failure, gout side effects: rash, sexual dysfucntion, cramps, increased BSL, increased lipids

Question 13

Describe when a b-blocker is recommended, contraindicated, and what the most common side effects are

Answer 13

recommended: anxious, young, post MI, migraine contraindicated: asthma/ COPD, CCF, PVD, heart block, brittle DM1 side effects: fatigue, insomnia, bronchospasm, sexual dysfunction

Question 14

Describe when amlodopine is recommended, contraindicated, and what the most common side effects are

Answer 14

recommended: asthma, angina, PVD, reynaud phenomenon contraindicated: heart block, CCF side effects: headache, flushing, ankle oedema, nausea, constipation, nocturia

Question 15

Describe when an ACEI is recommended, contraindicated, and what the most common side effects are

Answer 15

recommended: heart failure, PVD, diabetes, reynaud phenomenon contraindicated: bilateral renal artery stenosis, pregnancy side effects: cough, weakness, rash, angioedema

Question 16

Describe when a centrally acting agent eg clonidine or methyl dopa is recommended, contraindicated, and what the most common side effects are

Answer 16

recommended: asthma, pregnancy contraindicated: liver disease side effects: sedation, dry mouth, sexual dysfunction

Question 17

Describe when an a-blocker is recommended, contraindicated, and what the most common side effects are

Answer 17

recommended: asthma, PVD. CCF, prostatism contraindicated: heart failure, orthostatic hypotension side effects: weakness, palpitations, sedation, headache