hypertension

Question 1

what is normal BP

Answer 1

90/60 –> 140/90

Question 2

what is state 1 hypertension

Answer 2

clinic BP _> 140/90
+
ABPM day time average _> 135/85

Question 3

what is state 2 hypertension

Answer 3

clinic BP _> 160/100
+
ABPM _> 150/95

Question 4

what is severe hypertension

Answer 4

SBP > 180

DBP > 110

Question 5

is an ABPM required in severe hypertension

Answer 5

no - start drug treatment before ABPM

Question 6

what measurements should ABPM take

Answer 6

at least 2 measurements per waking hour for 14 days

Question 7

when is HBPM used

Answer 7

if unable to tolerate ABPM

Question 8

what measurements should HBPM take

Answer 8

2 consecutive measurements i minute apart for at least 4 days (7 days)
1st measurement is discarded

Question 9

what is the BP aim for under 80

Answer 9

140/90
or
135/85 ABPM

Question 10

what is the BP aim for over 80

Answer 10

150/90
or
145/85 ABPM

Question 11

what is some life advice for hypertension

Answer 11

reduce salt
reduce caffeine
lose weight
reduce alcohol
stop smoking
increase aerobic exercise

Question 12

what is the first line treatment for hypertension in under 55s

Answer 12

ACEI

ARB if dry cough

Question 13

if ACEI isn’t tolerated e.g. of child bearing potential what should used as treatment for hypertension in under 55s

Answer 13

beta blocker

Question 14

what is the first line treatment for hypertension in over 55s/afro-carribean

Answer 14

Calcium channel blocker

Question 15

what is the step 2 treatment for hypertension in under 55s

Answer 15

ACEI + CCB

Question 16

what is the step 2 treatment for hypertension in over 55/afro-carribean

Answer 16

CCB + ACEI/ARB

Question 17

what is the step 3 treatment for all in hypertension

Answer 17

+ thiazide diuretic

Question 18

what is the step 4 treatment for all in hypertension

Answer 18

increase thiazide diuretic
possibly add alpha or beta blocker
if low potassium - low dose spironolactone

Question 19

what is secondary hypertension

Answer 19

underlying disease

Question 20

what are some examples of underlying disease in secondary hypertension

Answer 20

renal artery stenosis (any renal disease) - excess renin release
pheochromocytoma (excess NA)
obstructive sleep apnoea
glomerulonephritis
conns syndrome (excess aldosterone)
cushings syndrome (excess cortisol)
hyperparathyroidism
aortic coarctation
intracranial tumour

Question 21

what is malignant hypertension

Answer 21

needs urgent treatment

Question 22

what are some causes of malignant hypertension

Answer 22

cerebral oedema (seen as papilloedema - swelling of optic disc)
acute renal failure
acute heart failure

Question 23

what is seen in malignant hypertension

Answer 23

blood vessels show fibrinoid necrosis and end arteritis proliferans of their walls

Question 24

what is primary hypertension

Answer 24

no obvious cause

- genetic, salt intake, protein intake

Question 25

what is essential hypertension

Answer 25

rise in BP of unknown cause that increases risk for cerebral, cardiac and renal events (BP > 140/90)

Question 26

what is the definition of hypertension

Answer 26

BP where treatment does more good than harm

Question 27

how do you diagnose postural hypotension

Answer 27

measure BP supine or seated
stand up 1 minute
measure BP again

Question 28

what drug is used for hypertension with prostatic hypertrophy

Answer 28

alpha blocker

Question 29

what drugs are good in diabetic neuropathy

Answer 29

ACEI/ARB