Hypertension

Question 1

How is hypertension defined?

Answer 1

> 140/90

Question 2

What is primary hypertension?

Answer 2

Hypertension with no obvious cause

Question 3

If someone’s BP in clinic is hypertensive, what is the next investigation to do?

Answer 3

Ambulatory blood pressure monitoring (ABPM)

Question 4

What is stage 1 hypertension? What is the management

Answer 4

> 140/90 or >135/85 ABPM

Usually just offer lifestyle advice, however, treat if:

• End organ damage
• Established CVS disease, renal disease or diabetes. Or 10 year CVS risk above 20%

End organ damage = hypertensive retinopathy, urine dipstick (proteinuria) or ECG showing LVF or IHD

Question 5

Classification and management of stage 2 and 3 hypertension?

Answer 5

Stage 2 = >160/100 or >150/95 ABPM

Stage 3 = >180 systolic or >110 diastolic

Question 6

Discuss the management of hypertension:

Answer 6

1st line: age < 55 = ACE I. Age > 55 or black = Calcium channel blocker

2nd line = A + C. (Ace inhibitor + Calcium Channel blocker)

3rd line = A + C + D (ACE + Calcium channel + diuretic)

NOTE: the use of indapamide is now preferred to bendroflumethiazide when using a thiazide diuretic.

Resistant hypertension: If potassium < 4.5 use spironolactone
If potassium >4.5 use a higher dose thiazide diuretic.

Question 7

What should be used in women of child bearing age?

Answer 7

Beta blockers (labetalol)

Question 8

What is first line in diabetics regardless of age?

Answer 8

ACE I

Question 9

What is the definition of malignant hypertension?

Answer 9

BP > 200/120

Question 10

What is the classical pathological feature seen in malignant hypertension?

Answer 10

Fibrinoid necrosis.

Question 11

Clinical features of malignant hypertension?

Answer 11

Headache, nausea, vomiting, visual disturbance.
Papilloedema
Encephalopathy (seizures)

Question 12

Management of malignant hypertension?

Answer 12

Oral therapy e.g. atenolol

If severe or encephalopathic use IV therapy e.g. IV labetalol/IV nitroprusside.