Hypertension

Question 1

What percentage of people with hypertension have essential/idiopathic hypertension?

Answer 1

95%

Question 2

Name 4 factors that would predispose an individual to developing hypertension

Answer 2

Sympathetic stimulation, genetics, activation of RAAS, endothelial dysfunction (less NO released), smoking, drinking, obesity, low birth weight

Question 3

What percentage of the adult population have essential hypertension?

Answer 3

40%

Question 4

Which ethnic group suffer hypertension more commonly?

Answer 4

Black people

Question 5

What sensory organ is often affected by hypertension?

Answer 5

Eyes (hypertensive retinopathy)

Question 6

What is grade 1 hypertensive retinopathy?

Answer 6

Increased vessel tortuosity and silver wiring

Question 7

What is the second stage of hypertensive retinopathy?

Answer 7

Grade 1 with arteriovenous nipping where thickened arteries cross over veins

Question 8

What is grade 3 hypertensive retinopathy?

Answer 8

As grade 2 but with soft cotton wool exudates and flame shaped haemorrhages

Question 9

What is grade 4 hypertensive retinopathy?

Answer 9

Grade 3 with pappiloedema

Question 10

What might urinalysis show?

Answer 10

Proteinuria, heamaturea due to renal damage

Question 11

What other investigation might you want to do?

Answer 11

Urea and creatinine levels, CXR (cardiomegaly), ECG and echo

Question 12

Treatment is aimed at keeping BP to what?

Answer 12

Below 140/90

Question 13

If diabetic what is the BP aim?

Answer 13

Below 130/85

Question 14

What are the three first line anti hypertensives?

Answer 14

ACEIs, CCBs, thiazide diuretics

Question 15

What drugs may be added I’d all three first line drugs are being used?

Answer 15

Alpha blockers, beta blockers, loop diuretic

Question 16

What is malignant hypertension?

Answer 16

A diastolic of over 130

Question 17

What does malignant hypertension cause?

Answer 17

Acute vascular damage and encepahlopathy

Question 18

What percentage of secondary hypertensives have a renal cause?

Answer 18

80%

Question 19

Name 5 causes of secondary hypertension?

Answer 19

Renal artery stenosis, chronic glomerulonephritis, chronic pyelonephritis, poly cystic kidney disease, phaechromacytoma, conn’s syndrome (hyper aldosteronism), coarctation of the aorta, pregnancy, oral contraceptive, steroids, ciclasporin

Question 20

When should you suspect secondary especially?

Answer 20

In young patients under 40

Question 21

What investigations would you do for secondary?

Answer 21

U and Es, urinalysis, cortisol, growth hormone, urinary catecholamines, CXR, MRI

Question 22

Difference between secondary and essential management?

Answer 22

Treat the cause but otherwise the same

Question 23

What is the definition of hypertension?

Answer 23

Hypertension is a systolic BP of over 140 or a diastolic of over 90