Hypertension

Question 1

What to do if in-office BP >140/90

Answer 1

see Evernote “Hypertension”

Question 2

What to do if BP 130-139/85-89

Answer 2

Annual Follow-Up

Question 3

Normal BMI & WC

Answer 3

BMI 18.5-24.9

WC <102 cm men, <88 cm women

Question 4

Investigations to order at hypertension visit 1 or 2

Answer 4

Urinalysis

Lytes

Cr

FGB

Lipids

ECG

ACR for diabetic patients only

Question 5

Management Options for new diagnosis Hypertension

Answer 5

1) Lifestyle only: F/U @ 3-6 month intervals
2) Meds: F/U Q1-2 months until 2 consecutive readings below target, then Q3-6 months

Question 6

When to initiate medications for hypertension?

Answer 6

BP >=160/100

or

>=140/90 with target organ damage/CV risk factors

Question 7

Med options for Hypertension

Answer 7

1st Line: thiazide, BB (<60), ACE (nonblack), long-acting CCB, ARB.

Good combos: Thiazide + CCB, CCB + ACE

**CAD: **ACE/ARB, + BB if angina/recent MI

**DM: **ACE + CCB better than ACE + thiazide

Question 8

Secondary Causes of HTN (list)

Answer 8

Renovascular

Endocrine

Pheo

Question 9

How to screen for hyperaldosteronism?

Answer 9

plasma aldosterone, plasma renin activity (AM sample, sitting position, resting at least 15 min. Must stop aldosterone antagonists, ARBS, BB and clonidine before test).

If +ve:

i) saline loading/oral sodium test/oral Na loading + fludrocortisone, etc.

IF +ve: CT/MRI –>specialist if normal imaging

Question 10

Medical treatment for primary hyperaldosteronism.

Answer 10

Spirinolactone 25-400 mg per day or amiloride 10-20 mg/day. May add thiazides or BB’s/CCB’s.

Question 11

How to screen for pheo

Answer 11

24 hour urinary total metanephrines (95% sensitive) + metanephrine:Cr ratio (100% sensitive), then MRI/CT to localize

Question 12

Perindopril (Coversyl)

Dosing, side-effects, monitoring.

Answer 12

Start at 2-4 mg daily, increase Q4 weeks to max 8 mg

Side-effects: Headache 25%, Cough 10%, hyper K <1%

Monitor lytes, cr 1-2 weeks after starting and periodically thereafter

Question 13

Ramipril Dosing

Answer 13

1.25 mg, 2.5 mg, max 10 mg daily

Question 14

Indapamide Dosing, Side effects, monitoring

Answer 14

1.25-2.5 mg daily, may increase to 5 mg daily after 1 week

Hypo K (5%),

Question 15

Hctz Dosine, Side-Effects, Monitoring

Answer 15

25-100 mg daily divided BID or daily (also comes in 12.5 mg)

Side effects varied, prevalence not defined.

Hypo K

Question 16

Amlodipine dosing, side-effects, monitoring

Answer 16

5 mg PO, titrate by 2.5 mg up to max 10 mg

Peripheral/Pulmonary edema (esp in HF patients) 2-10%

No lab monitoring needed

Question 17

CHEP targets for BP > 80 years of age (non-diabetic)

Answer 17

<150/90

Question 18

Lifestyle Changes Recommendations

Answer 18

• Weight loss target BMI to 18.5 to 24.9 WC < 94 cm men and < 80 cm women
• Dietary changes fruits, veggies, fibre, non-animal protein low chol/fat low fat dairy products dec NaCl to < 2000 mg per day ( about 1 tsp) DASH – dashdiet.org
• Regular exercise 30 to 60 min of moderate intensity 4 to 7 days/week
• Reduce EtOH <14 drinks/week men and < 9 drinks/week women
• Stress reduction therapies
• Smoking cessation