Hypertension

Question 1

Risk factors for HTN

Answer 1

Age
Genetics
Environmental stress
Diet (Na+)
Alcohol
Weight
Race (Afro-caribbean)
Birth weight

Question 2

Stage 1 HTN measurements:

Answer 2

Clinic: >140/90
ABPM: avg >135/85

Question 3

Stage 2 HTN measurements:

Answer 3

Clinic: >160/100
ABPM: avg >150/95

Question 4

‘severe’ HTN measurements:

Answer 4

Systolic >180

Diastolic >110

Question 5

What percentage of hypertension is idiopathic?

Answer 5

90%

Question 6

Factors in assessing risk of CVD

Answer 6

ASSIGN score
MI, Stroke, IHD
Smoking
DM
Hypercholesterolaemia
Family history
Physical examination
Organ damage (assess)

Question 7

By what amound does smoking effect blood pressure?

Answer 7

+20/10mmHg

Question 8

What percentage of hypertension is attributable to obesity?

Answer 8

30%

Question 9

What are the causes of secondary hypertension?

Answer 9

Drugs
Renal disease
Endocrine disease
Pregnancy
Coarctation
OSAS

Question 10

What is the most effective form of BP monitoring?

Answer 10

Ambulatory BP monitoring

Question 11

You don’t stop one drug, you…

Answer 11

add more on top

Question 12

What is recommended for a stage 1 hypertensive under 40?

Answer 12

Specialist evaluation

Question 13

Which stage 1 Hypertensives receive treatment?

Answer 13

Only those with:
Renal/organ damage
CVD
DM

Question 14

Which stage 2 hypertensives receive treatment?

Answer 14

All

Question 15

Hypertensive <55 given what first?

Answer 15

ACEI/ARB

Ramipril

Question 16

Why are ACEI/ARB not recommended for afrocaribbeans/pregnant women?

Answer 16

Afrocaribbeans: angioedema

These are teratogens

Question 17

Step 1 treatment for hypertensive >55y

or <55 and cannot take ACEIs

Answer 17

CCBs

Question 18

When are thiazide-type diuretics offered to step 1 patients?

Answer 18

CCBs ineffective/intolerant

Patients with oedema

Question 19

Step 2 treatment for HTN

Answer 19

Add thiazide-like diuretic to CCB/ACEI

Chortalidone, Indapamide

Question 20

Step 3 treatment for HTN

Answer 20

CCB, ACEI, Diuretic

Question 21

Step 4 treatment for HTN

Answer 21

ENSURE COMPLIANCE
Assess blood K+
High: low-dose Spironolactone
Low: Higher dose Diuretic

Question 22

Contraindications for ACEI

Answer 22

Renal artery stenosis
Renal failure
Hyperkalemia

Question 23

What drugs do ACEI interact with?

Answer 23

NSAIDS
K+ supplements
K+ sparing diuretics

Question 24

Side effects of ACEI

Answer 24

Cough
1st dose Hypotension
Renal impairment
Angioedema

Question 25

When are ARBs preferred?

Answer 25

When the body compensates for ACEI

Superior to beta blockers

Question 26

Contraindications for Vasodilating CCBs?

Answer 26

MI
Bradycardia
HF

Question 27

Side effects of CCBs

Answer 27

Flushing
Headache
Ankle Oedema
Reflux

Question 28

Less used drugs in HTN

Answer 28

Alpha-adrenoreceptor antagonists (Doxazosin)
Centrally acting agents (Methyldopa)
Vasodilators

Question 29

How is pre-eclampsia characterised?

Answer 29

Rapid rise in blood pressure at 20 weeks

Proteinurea

Question 30

What is gestational hypertension?

Answer 30

Rise in blood pressure to hypertension during pregnancy

Question 31

When are Beta blockers contra-indicated?

Answer 31

Asthma
Heart block
Acute heart failure

Question 32

What are the treatable causes of hypertension?

Answer 32

Renal Artery Stenosis
Cushings
Conn’s
Sleep apnoea

Question 33

When should treatment be started relative to risk?

Answer 33

CVD risk 20% in 10 years

Question 34

How does ACE work?

Answer 34

Converts angiotensin 1 to angiotensin 2

Question 35

How do CCBs work?

Answer 35

Block L-tyle calcium channels, relaxing small arteries and reducing resistance

Question 36

What is malignant hypertension?

Answer 36

Acute massive rise in BP (usually >180)

Papilloedema +/- retinal haemorrhage

Question 37

What is malignant hypertension associated with?

Answer 37

Heart Failure
Kidney failure
Cerebral oedema