Hypertension

Question 1

when to treat

Answer 1

all with BP >160/100

for those >140/90 the decision depends on coronary events, presence of diabetes and end organ damage

Question 2

isolated HTN

Answer 2

the most common in the UK, affecting >59% of over 60s
results from stiffening of the large arteries (arteriosclerosis)
not benign
doubles risk of MI, triples risk of CVA

Question 3

malignant HTN

Answer 3

rapid rise in BP leading to vascular damage - pathological hallmark is fibrinoid necrosis
usually there is severe HTN (eg>200/130) and there is bilateral retinal haemorrhage and exudates. papilloedema may or may not be present

Sx are common:
headache, visual disturbance

requires urgent treatment

may precipitate renal failure, heart failure, or encephalopathy

Question 4

treatment goal

Answer 4

<140/90
<130/80 in diabetes, 150/90 if over 80yo
reduce BP slowly, rapid reduction can be fatal, especially in the context of an acute stroke

Question 5

lifestyle changes

Answer 5

stop smoking
low fat diet
reduce alcohol and salt intake
increase exercise
lose weight if obese

Question 6

drug therapy

Answer 6

B-blockers and thiazides may increase the risk of DM, Ca channel blockers are neutral and ACEi and ARBs reduce the risk

monotherapy:
if >55yo, and any age black patients, 1st choice is a Ca channel blocker or thiazide
if <55yo 1st choice is ACEi (ARB if ACEi intolerant eg cough)
consider B-blocker in women attempting to get pregnant as ACEi and ARBs have teratogenic effect
chlorothiazide also has a teratogenic effect

Question 7

NICE defiinitions

Answer 7

stage 1:
clinic BP >140/90, ambulatory >135/85

stage 2:
clinic 160/100
ABPM >150/95

severe:
clinic BP >180/110

Question 8

thiazide diuretics

Answer 8

block thiazide sensitive Na/Cl symporter in the DCT and reduce reabsorption of Na and Cl