Hypertension

Question 1

What BP is Stage 1 hypertension?

Answer 1

In surgery = >140/90 mmHg

HBPM = >135/85 mmHg

Question 2

What BP is stage 2 hypertension?

Answer 2

In surgery = >160/110 mm Hg

ABPM = >150/95 mm Hg

Question 3

What BP is severe hypertension?

Answer 3

> 180/110 mmHg

Question 4

What are the major risk factors of hypertension? (8)

Answer 4

Obesity
Lack Exercise
Diabetes
>65yrs
Black ethnicity
Sleep apnea 
Family History
Alcohol

Question 5

What are the weak risk factors of hypertension? (3)

Answer 5

Increased sodium intake
Low fruit and veg
Dyslexia emit

Question 6

What are the diagnostic factors of hypertension?

Answer 6

Key
~BP = >140/90
~Retinopathy
~Asymptomatic

Question 7

What is stage 1 medical treatment of hypertension for

Answer 7

ACE inhibitor

Or

Angiotensin II Receptor Antagonist

Question 8

What is stage 1 medical treatment for hypertension for >55yrs or patient of black ethnicity?

Answer 8

Ca2+ channel blocker

Question 9

What is stage 2 medical treatment of hypertension?

Answer 9

ACEi or A2R blocker

AND

Ca2+ channel blocker

Question 10

What is stage 3 medical treatment of hypertension?

Answer 10

ADD

Thiazide like diuretic
E.g. Chlorthalidone/indapamide

Question 11

What is stage 4 medical treatment of HTN?

Answer 11

IF
K+ 4.5mmol = increase thiazides dose

IF further diuretic not tolerated
Alpha blocker (e.g. doxazosin, terazosin, prazosin)
OR
Beta-blocker (e.g. Atenolol/propranolol IF w/ angina or MI OR bisoprolol/carvediol IF w/ HF)

Question 12

What is the MOA of ACEi?

Answer 12

1. Stop angiotensin I ==> II
2. Decrease angiotensin II = decrease aldosterone
3. = increase Na+ excretion = increase H2O excretion
4. = decrease blood volume
5. Decrease angiotensin II = decrease vasoconstriction

Question 13

What are the main side effects of ACEi?

Answer 13

~Dry cough
~Hypotension (esp given w/ diuretic

NB: NEVER give to renal artery stenosis - must do renal check 2 weeks after starting

Question 14

What are main side effects of angiotensin II Receptor blockers?

Answer 14

(Usually mild)
~symptomatic hypotension (dizziness)
~Hyperkalaemia

Question 15

What is the MOA of calcium antagonists?

Answer 15

1. Inhibit Ca2+ entry through voltage gated ion channels in arterial smooth muscle cells
2. Decrease Ca2+ binding to calmodulin
3. Decrease contraction of smooth muscle cells

Question 16

What are the main side effects of calcium antagonists?

Answer 16

~Flushing
~Ankle oedema

~DILTIAZEM = cardiac depression w/ beta blockers

Question 17

What is the MOA of thiazides?

Answer 17

1. Decrease Na+/Cl- cotransporter in distal tubule
2. Increase Na+ excretion
3. Increase H2O excretion
4. = reduced blood volume

Question 18

What are the main side effects of thiazides?

Answer 18

~Increased urinary frequency
~Impaired glucose tolerance
~Erectile dysfunction
~Hypokalaemia 
~Hyponatraemia
~Hypomagnesium

Question 19

Define malignant HTN?

Answer 19

BP >180/110mmHg

Question 20

What are the key symptoms in malignant HTN?

Answer 20

Dizziness/headaches/increased mental confusion
Decreased sensory/motor function
SOB/Cardiac pain/Oedema
Oliguria/polyuria
Fundoscopy = papilloedema/retinal exudates/retinal haemorrhage

Question 21

What is the management of malignant HTN?

Answer 21

IV nitroprusside (or labetolol / nicardipine)