Hypertension

Question 1

What blood pressure is classed as Stage 1 hypertension?

Answer 1

140/90 mmHg clinically, and 135/85mmHg at home

Question 2

What blood pressure is classed as Stage 2 hypertension?

Answer 2

160/100mmHg clinically and 150/95mmHg

Question 3

What blood pressure is classed as Stage 3 hypertension?

Answer 3

180mmHg systolic or 110mmHg diastolic clinically

Question 4

What kinds of end organ damage can occur with hypertension?

Answer 4

• Left Ventricular Hypertrophy
• Creatinine Raised
• Albuminuria / microalbuminuria
• Retinopathy

Question 5

Which tests should be offered to be people who have been diagnosed with hypertension?

Answer 5

• Test urine for presence of protein
• Take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
• Examine fundi for hypertensive retinopathy
• Arrange a 12-lead ECG.

Question 6

What are some of the common and the uncommon causes of secondary hypertension?

Answer 6

Common:
- Renal disease
- Obstructive Sleep Apnoea
- Aldosteronism
- Reno-vascular Disease
Uncommon:
- Cushing’s
- Pheochromocytoma
- Hyperparathyroidism
- Aortic coarctation
- Intracranial tumor

Question 7

Primary Aldosteronism/Conn’s Syndrome

Answer 7

Involves excess production of the hormone aldosterone by the adrenal glands resulting in low renin levels, and excessive reabsorption of sodium and water

Question 8

Pheochromocytoma

Answer 8

Neuroendocrine tumor of the medulla of the adrenal glands that failed to involute after birth. It secretes high amounts of catecholamines, mostly norepinephrine

Question 9

What level of weight loss is equivalent to taking anti-hypertensives?

Answer 9

6kg is therefore the same as taking anti- hypertensive drugs

Question 10

By how much does a no added salt diet reduce BP?

Answer 10

2-4 mmHg

Question 11

By how much does aerobic exercise reduce BP?

Answer 11

3.8/2.6 mmHg

Question 12

What is the difference between absolute and relative risk?

Answer 12

Relative risk is used to compare the risk in two different groups of people. Absolute risk of a disease is your risk of developing the disease over a time period. Can reduce everyone’s relative risk of CVS but much harder to reduce absolute risk of CVS. Eg. Reducing relative risk in an 80 year old smoker, would still have a very high absolute risk

Question 13

True or False: ACE inhibitors should be avoided in pregnant women

Answer 13

True, they are teratogenic

Question 14

True or False: There are more side effects when using combined therapies than monotherapy

Answer 14

False, there a more side effects with mono therapy

Question 15

What is the most effective treatment for resistant hypertension?

Answer 15

Spironolactone (start low, go slow)

Question 16

What are new technologies used with hypertension?

Answer 16

• Renal denervation: minimally invasive, endovascular catheter based procedure using radiofrequency ablation or ultrasound ablation aimed at treating resistant hypertension
• Baroreceptor stimulation: Recently an implantable device to electrically stimulate the carotid baroreceptors, to decrease sympathetic outflow
• Rox coupler: placed between the artery and vein in the upper thigh to allow a calibrated amount of blood to flow between them

Question 17

Stable hypertension

Answer 17

BP stays high consistently and doesn’t change much

Question 18

Labile hypertension

Answer 18

Fluctuates

Question 19

Blood pressure =

Answer 19

Cardiac output x total peripheral resistance

Question 20

What percentage of hypertension cases are primary?

Answer 20

90%

Question 21

Cushing’s Syndrome

Answer 21

Excess corticosteroid

Question 22

Conn’s Syndrome

Answer 22

Excess aldosterone

Question 23

True or False: Every 10mmHg of diastolic pressure above 85 doubles risk of MI and every 8mmHg of diastolic pressure above 85 doubles risk of stroke

Answer 23

True