Hypertension

Question 1

What is a high BP in clinic?

Answer 1

> 140/90

Question 2

What should be offered if BP>140/90 in clinic?

Answer 2

Ambulatory BP Monitoring or Home BP monitoring (ABPM/HBPM)

Question 3

What if ABPM is 135/85 or more?

Answer 3

Stage 1 hypertension
Treat if < 80 years and any of:
Target organ damage
Established CVS disease
Renal disease
Diabetes
10 year CVS risk is high 20%

Question 4

What if ABPM is 150/95 or more?

Answer 4

Treat all patients

Question 5

What if ABPM < 135/85

Answer 5

Not hypertensive

Monitor

Question 6

Why is ABPM/HBPM required?

Answer 6

White-coat hypertension - elevated clinic pressure but normal ABPM as patients BP may rise in clinical settings.
ABPM/HBPM confirm diagnosis of HTN

Question 7

What is stage 1 hypertension?

Answer 7

Clinic BP 140/90 or more

ABPM subsequently 135/85 or more

Question 8

What is stage 2 hypertension?

Answer 8

Clinic BP 160/100 or more

ABPM subsequently 150/95 or more

Question 9

What is severe hypertension?

Answer 9

Clinic BP systolic 180 or more OR clinic diastole 110 or more

Question 10

What should be considered if clinic BP os equal or over 180/110

Answer 10

Severe hypertension
Consider immediate treatement
Consider referral if signs of papilloedema or retinal haemorrhages
Refer if pheochromocytoma suspected - postural hypotension, headache, palpitation, pallor and diaphoresis (sweating)

Question 11

HOW does ambulatory BP monitoring work?

Answer 11

At least 2 measurements per hour during person’s usual waking hours
Use average of at least 14 measurements

Question 12

How does HBPM work?

Answer 12

2 consecutive measurements taken, 1 min apart
BP recorded twice daily - morning and evening
Ideally fo 7 days

Question 13

How should you confirm diagnosis of hyeprtension

Answer 13

If first reading is 140/90 or more
Take second reading
Use lower reading to determine further management.

Measure blood pressure in both arms - if difference is more than 20, repeat. If this remains use the higher reading.
Consider causes of unequal BP - supravalvular aortic stenosis

Offer ABPM/HBPM

Question 14

What are causes of hypertension?

Answer 14

Primary (Essential) idiopathic 95%
Secondary:
Renal:
intrinsic- glomerulonephritis, chronic pyelonephritis, adult polycystic kidneys, polyarteritis nods, systemic sclerosis, renovascular disease

Endocrine:
Primary hyperaldosteronism
Phaeochromocytoma
Cushing's
Conn's
Congenital adrenal hyeprplasia
Acromegaly
Hyperparathyroidism

Other:
Coarctation
Pregnancy
NSAIDs
Glucocorticoids
COCP
Cocaine
Amphetamines

Question 15

What are signs and symptoms of high BP?

Answer 15

Usually asymptomatic unless very high (>200/130), then:
headaches
visual disturbances
seizures

Question 16

What investigations for HTN?

Answer 16

Bedside:
Urine dipstick for renal disease as cause/consequence
Fundoscopy - check for retinopathy
ECG for LVH or IHD

Bloods
TFT
U&E - renal disease as cause or consequence
LFT
FBC
Fasting glucose
Cholesterol and lipids - hyperlipidaemia
HbA1c - check for DM

Imaging
Echo for hypertrophy
US KUB for renal artery stenosis