Hypertension

Question 1

what is the definition of hypertension

Answer 1

> 140mmHg +/ 90mmHg on 3 separate occasions

record lowest reading

Question 2

what is the definition of malignant hypertension

Answer 2

> 200/130mmHg

Question 3

what is the aetiology of hypertension

Answer 3

primary
-idiopathic in 90% of cases
secondary
-renal
-endocrine
-cardiovascular
-drugs
-pregnancy (pre-eclampsia)

Question 4

what are the renal causes of HTN

Answer 4

renal artery stenosis
chronic glomerulonephritis
chronic pylonephritis
polycystic kidney disease
chronic renal failure

Question 5

what are the endocrine causes of HTN

Answer 5

DM
hyperthyroidism
Cushings syndrome
Conns syndrome
hyperparathyroidism
phaeochromocytoma
congenital adrenal hyperplasia
acromegaly

Question 6

what are the cardiovascular causes of HTN

Answer 6

aortic coarctation

increased intravascular tone

Question 7

what are the drugs which case HTN

Answer 7

sympathomimetics
corticosteroids
COCP

Question 8

what is the epidemiology of HTN

Answer 8

very common

increases with age

Question 9

what is the history associated with hypertension

Answer 9

often asymptomatic

symptoms of complication/cause

Question 10

what is the history associated with malignant hypertension

Answer 10

scotomas (visual field loss)
blurred vision
headaches
acute HF
seizures
nausea
vomiting

Question 11

what would be the expected examination findings in hypertension

Answer 11

loud 2nd HS/presence of 4th HS
radioradial delay (aortic coarctation)
radiofemoral delay (aortic dissection)
renal artery bruit (renal artery stenosis)

Question 12

what is the Keith Wagner Classification of retinopathy in hypertension

Answer 12

I ‘silver wiring’
II plus arteriovenous nipping
III plus flame haemorrhages and cotton wool exudates
IV plus papilloedema

Question 13

what is the difference between cotton wool spots (soft exudates) and flame haemorrages (hard exudates)

Answer 13

soft exudates-ischaemia

hard exudates-cholesterol

Question 14

what is the pathology of hypertension

Answer 14

fibrotic intimal thickening of arteries
reduplication of elastic lamina and SM hypertrophy
arteriolar wall layers are replaced by pink hyaline material
luminal narrowing occurs

Question 15

what investigations would be performed in suspected hypertension

Answer 15

1 BP: >140/90
2 ECG
-signs of LVH, ischaemia or infarction
3 bloods
-UEs, glucose
-lipids (high LDL, low HDL)
3 urine dipstick
-increased albumin excretion suggests end-organ damage
-proteinuria
4 ambulatory BP monitoring
-excludes 'white coat syndrome'
-allows monitoring of treatment response

Question 16

what are the signs of LV hypertrophy

Answer 16

deep S wave in V1-2
tall R wave in V5-6
inverted T waves in I, AVL, V5-6
LAD

Question 17

what are the lifestyle changes for conservative management of hypertension

Answer 17

stop smoking
lose weight
reduce alcohol
reduce salt

Question 18

when would investigation for secondary causes form part of the management of hypertension

Answer 18

in young patients
in malignant hypertension
with poor response to treatment

Question 19

what are the indications for medical treatment of hypertension

Answer 19

> 160mmHg SBP
100mmHg DBP
evidence of end-organ damage

Question 20

what are the medical treatments available for management of hypertension

Answer 20

1 thiazide diuretics (bendroflumethiazide)
2 ACE inhibitors (ramipril)/ Angiotensin II antagonists (losartan)
3 CCBs (amlodipine)
4 B-blockers (atenolol)
5 A-blockers (doxazosin)

Question 21

what is the 1st line treatment for hypertension in <55yrs

Answer 21

ACE inhibitor

Question 22

what medication would be given for hypertension in >55yrs/black people

Answer 22

CCB (amlodipine)

Question 23

what medication would be given for hypertension in <55yrs/diabetics/HF/LV dysfunction

Answer 23

ACE inhibitors (ramipril)
angiotensin II antagonist (losartan)

Question 24

what medication would be given for hypertension in >60yrs+black

Answer 24

CCBs (amlodipine)

Question 25

what two hypertensive medications should not be given together and why

Answer 25

thiazide diuretic and beta-blockers

to reduce risk of developing diabetes

Question 26

what is another use of a-blocker (doxazosin)

Answer 26

in prostatism

for outlet obstruction at neck of bladder caused by benign prostatic hypertrophy

Question 27

what is the target BP for patients with hypertension

Answer 27

<140/85mmHg in non-diabetics
<130/80mmHg in diabetics without proteinuria
<125/75mmHg in diabetics with proteinuria

Question 28

what medications would be used in severe hypertension (>140mmHg DBP)

Answer 28

atenolol/nifedipine

Question 29

what medications would be used in acute malignant HTN

Answer 29

IV beta blocker

Question 30

why should rapid lowering of BP be avoided

Answer 30

can cause cerebral infarction

Question 31

what complications are associated with hypertension

Answer 31

HF, CAD, MI
cerebrovascular accident
peripheral vascular disease
emboli
retinopathy
renal failure
hypertensive encephalopathy
posterior reversible encephalopathy sydrome
malignant HTN

Question 32

what is the prognosis associated with hypertension

Answer 32

if uncontrolled:
6x stroke risk
3x cardiac risk

Question 33

what is the criteria for controlling blood pressure in those with chronic kidney disease and DM

Answer 33

start medication if BP >140/90

Question 34

risk factors

Answer 34

obesity
little or no exercise
alcohol intake