Hypertension

Question 1

Definition

Answer 1

Systolic > 140mmHg
Diastolic > 90mmHg

(with 2 consecutive readings)

Question 2

What’s essential hypertension

Answer 2

primary, the cause is unknown
95% of cases
ECF volume 15% increase. hypertension is a response to increased blood volume

Question 3

Aetiology

PREDICTION

Answer 3

P - primary
R - renal: RAS, GN, APKD, PAN
E - endo: raised T4, Cushing’s, phaeo, acromegaly, Conn’s
D - cocaine, NSAIDs, OCP
I - ICP raised
C - CoA
T - toxaemia of pregnancy (PET) - also preeclampsia
I - increased viscosity
O - overload with fluid
N - neurogenic: diffuse axonal injury, spinal section

Question 4

Complications of HTN

Answer 4

End-organ damage: CANCER

Cardiac:

• IHD
• LVH –> CCF
• AR, MR

Aortic

• aneurysm
• dissection

Neuro

• stroke 6x !!
• encephalopathy (malignant HTN)

Eyes: hypertensive retinopathy

Renal: proteinuria, CRF

Question 5

Ix

Answer 5

24hr AMPB
Urine: haematuria, alb:Cr ratio
Bloods: FBC, U+Es, eGFR, glucose, fasting lipids
12 leads ECG: LVH, old infarct
Calculate 10yr CV risk

Question 6

Lifestyle/modifiable RFs

Answer 6

lower salt intake
reduce alcohol consumption
stop smoking
reduce weight
stress - relax

Question 7

Step 1 in antihypertensive Rx

Answer 7

if 55 / black: C

if <55: A

Question 8

Step 2 in Rx

Answer 8

C + A

Question 9

Step 3 in Rx

Answer 9

C + A + D

Question 10

Step 4 in Rx

Answer 10

Resistant HTN:

C + A + D + consider further diuretic or alpha-blocker or beta-blocker

Question 11

Why should you avoid thiazides and B-blockers?

Answer 11

increased risk of DM

Question 12

only consider B-B if…?

Answer 12

young and ACE-i/ARB not tolerated

Question 13

Whats the treatment goal?

Answer 13

80)

Question 14

3 types of diuretics

Answer 14

thiazides: most common e.g. bendroflumethaizide
loop diuretics (frusemide) - used in resistant cases
potassium sparing diuretics

Question 15

what do thiazides do?

Answer 15

block reabsorption of sodium at distal convoluted tubule of kidney

Question 16

Side effects of ACE-i

Answer 16

bradykinin-mediated: angio-oedema (face, tongue, throat), persistent dry cough (20%)

Question 17

2 subclasses of CCBs

Answer 17

dihydropyridines e.g. nifedipine: peripheral vasodilators
AE: headache/palpitations, peripheral oedema

verapamil: negative inotrope & vasodilator
SEs: HF, constipation

Question 18

Calcium movement out of the cell:

Answer 18

Ca ATP-ase/Ca exchange

Question 19

Calcium movement into the cell

Answer 19

non-specific leak, receptor-operated, voltage gated

Question 20

example of an ARB

Answer 20

valsartan

direct antagonist at angiotensin II receptors on muscles surrounding blood vessels