Hypertension

Question 1

Types of hypertension

Answer 1

Stage 1: Clinic BP > 140/90
Stage 2: Clinic BP > 160/100
Severe: Clinic BP > 180/110
Malignant: BP > 180/110 + papilloedema and/or retinal
haemorrhage
Isolated SHT: SBP ≥140, DBP <90

Question 2

Causes of HTN (PREDICTION)

Answer 2

Primary: 95%
Renal: RAS, GN, APKD, PAN
Endocrine: ↑T4, Cushing’s, phaeo, acromegaly, Conn’s
Drugs: cocaine, NSAIDs, OCP
ICP↑
Coarctation of aorta
Toxaemia of Pregnancy (PET)
Increased viscosity
Overload with fluid
Neurogenic: diffuse axonal injury, spinal section

Question 3

End organ damage in HTN (CANER)

Answer 3

1) Cardiac - IHD, L ventricular hypertrophy, Aortic/mitral regurg
2) Aortic - Aneurysm, Dissection
3) Neuro - Stroke, Encephalopathy
4) Eyes - hypertensive retinopathy
5) Renal - Proteinuria, CKD

Question 4

HTN investigations

Answer 4

24h ABPM
Urine: haematuria, Alb:Cr ratio
Bloods: FBC, U+Es, eGFR, glucose, fasting lipids 12 lead ECG: LVH, old infarct
Calculate 10yr CV risk

Question 5

HTN treatment

Answer 5

1) ACEi or ARB if <55yrs, Calcium channel blocker(CCB) if >55 or black
2) ACEi/ARB + CCB
3) ACEi/ARB + CCB + Thiazide like Diuretic
4) (resistant hypertension) Add further diuretic or a/B blocker

Question 6

Treatment of malignant HTN

Answer 6

Controlled reduction in BP to avoid stroke
Atenolol or long acting calcium channel blocker
If encephalopathy or congestive cardiac failure: frusemide and nitroprusside (monitor intra-arterial BP)