Hypertension

Question 1

NICE recommendation for ambulatory blood pressure monitoring?

Answer 1

Should be offered to all patients with clinic BP of more than 140/90

Question 2

Investigations in a hypertensive patient:

a) urinalysis
b) blood tests
c) fundoscopy
d) ecg

Answer 2

a) protein, albumin : creatinine ratio, haematuria
b) glucose, eGFR, cholesterol
c) to detect hypertensive retinopathy
d) to detect left ventricular hypertrophy

Question 3

Secondary causes of hypertension? (5)

Answer 3

Renal parenchymal disease
Renal artery stenosis
Primary aldosteronism
Phaeochromocytoma
Cushing's syndrome

Question 4

Modifiable risk factors for essential hypertension

Answer 4

Level of physical exercise
Alcohol consumption
Dietary sodium (<6/day)
Weight management
Smoking
Caffeine intake reduced

Question 5

The treatment target for BP in under 80 year olds and over 80 year olds?

Answer 5

140/90

150/90

Question 6

Step 1 in hypertension treatment algorithm?

Answer 6

Patients under 55- ACE inhibitor or ARB (A)

Patients over 55/Caribbean- Calcium blocker (C)

Question 7

In what circumstances is a thiazide offered as first-line?

Answer 7

If calcium blocker is contraindicated (e.g. heart failure) or not tolerated (ankle oedema)

Question 8

Step 2 therapy?

Answer 8

A + C

Question 9

Step 3 therapy?

Answer 9

A + C + D(iuretic) [thiazide]

Question 10

Blood pressure targets?

a) over 80 years
b) under 80 years

Answer 10

a) 150/90

b) 140/90

Question 11

New anti-hypertensives?

Answer 11

Aliskerin- direct renin inhibitors

Question 12

What are now the thiazides of choice?

Answer 12

Chlorthalidone

Indapamide

Question 13

Commonest cause of secondary hypertension?

Answer 13

Primary hyperaldosteronism

Question 14

Renal conditions causing secondary hypertension? (4)

Answer 14

Renal artery stenosis
APKD
Glomerulonephritis
Pyelonephritis