Hypertension

Question 1

Causes of HTN

Answer 1

Primary 95% Secondary 5%

Question 2

Secondary causes of HTN

Answer 2

Renal disease Endocrine Coarctation of aorta Others - COCP, Polycythaemia rubra Vera Toxaemia of pregnancy, neurogenic cause eg ICP, Hypercalacemia

Question 3

Renal secondary causes of HTN

Answer 3

Renal artery stenosis Chronic pyelonephritis Analgesic nephropath Glomerulonephritis Polycystic disease Diabetic nephropath you Reflux nephropath

Question 4

Endocrine causes of secondary HTN

Answer 4

Cushing syndrome Conn’s syndrome - most common Phaeochromocytoma Acromegaly Thyrotoxicosis Hypothyroidism

Question 5

How common is it

Answer 5

25% have it 35% of those aren’t aware

Question 6

Stages of HTN

Answer 6

Prehypertension 120-139 and 80-89

Stage 1 HTN 140-159 and 90-99

Stage 2 HTN 160-179 and 100-109

Stage 3 severe HTN 180 and 110

Question 7

Hx Q to ask a HTN pt

Answer 7

Symptoms: dizziness, headache (occipital), visual changes. Sleep apnoea, How much salt in your diet Increase wt Alcohol exercise Do you measure BP at home? What readings Medications Are you taking arthritis medication e.g. steroids Kidney problems: blood in urine, able swelling, SOB. Secondary causes: renal disease, endocrine dx, coarctation of aorta, COCP, polycythaemia ruba vera, Preeclampsia

Question 8

Ex of HTN

Answer 8

GI for signs of cushing syndrome, acromegaly, CKD, polycythemia Vital - HTN, Postural, strong PR, Check RR and RF pulse. Temp, BSL, BMI, RR Hands - xanthomata Eyes- HTN retinopathy, sclera haemorrhages, xantholasmas, Arcus senilis Neck - Carotid pulse Chest - Heaving hyper dynamic apex beat, thrill, parasternal impulse, S4 and loud A2 Resp - basal crackles Abdo - Ascites, collateral veins, masses, P - tenderness, masses, liver, aortic, kidney, P- liver venous hum, A- renal and aorta Legs- oedema, perfusion, pulses, xanthomata on achilles tendon For completion - neuro for previous CVA and PVD examination

Question 9

Grades of HTN retinopathy

Answer 9

Grade 1 Thickening of arterioles - silver wire arteries

Grade 2 Focal arteriolar spasm - AV nipping

Grade 3 Haemorrhage (flame shaped), exudates cotton wool (ischeamic), Hard waxy (lipid deposit).

Grade 4 Papilloedema

Question 10

Complications of HTN

Answer 10

• Chronic organ damage
  
  • IHD
  • Benign nephrosclerosis
  • Haemorrhagic stroke
  • Retinopathy
• LVH
• RVH

Question 11

Dx of HTN

Answer 11

Hypertension defined as:

Systolic > 140 mmHg or diastolic > 90mmHg

BP (min 3 separate occasions) exceeds threshold which predict increased CVD risk

Australian guidelines advise medication treatment when

Systolic 160 mmHg or greater

Diastolic 95-100 mmHg or greater

Patients with co-morbid risk factors (obesity, smoking etc.) should commence anti-hypertensive medication at 140/90-95 mmHg

Question 12

Management of HTN

Answer 12

• Lifestyle modication
  
  • at least 30 min of exercise per day
  • Quit smoking - Bupropion if greater then 10 smokers per day.
  • aim and maintain waist less then 94cm in men and 80cm in women or BMI less then 25
  • Reduce Na and fats to less then 4g/day or 65mmol/day
  • Limit alcohol intake to less then 2 drinks per night of men and 1 for women.
• Medications
  
  • High risk = drugs (even if BP not really high) and lifestyle meds, RV6-12 wkly, Target 140/90 or 130/80 if diabetic or proteinuria
  • Moderate risk = Lifestyle advise, +/- BP, or lipid if lifestyle changes not worked after 3 month and bp >160/100. RV 6-12 wkly
  • Low risk = Lifestyle advise,- RV 6-12 wks
  • ACE i eg Ramipril
  • Calcium channel blocker eg amlodipine
  • Thiazide eg hydrochlorothiazide

Question 13

What combination of medication do you have to be careful of when treating with antiHTN

Answer 13

ACE inhibitor (or angiotensin II receptor antagonist) + potassium sparing diuretic.

Triple wanbie = acute renal failure due to diuretic and NSAIDs constrict afferent vessels and ACE i dilated efferent vessels

Beta blocker + verapamil

ACE inhibitor + angiotensin II receptor antagonist