Hypertension

Question 1

WHO defines hypertension as a blood pressure greater than 120/80. True/False?

Answer 1

False

Hypertension is classically BP greater than 140/90

Question 2

How does eating salt increase blood pressure?

Answer 2

Increases release of aldosterone, which causes salt and fluid retention [part of RAAS]

Question 3

What are some common causes of secondary hypertension?

Answer 3

Renal disease/stenosis
Endocrine disease
Coarctation of aorta
Obstructive sleep apnoea
Drug therapy inc. CCSs

Question 4

How can renal disease lead to hypertension?

Answer 4

Reduced renal flow causes excess renin release, ultimately leading to fluid overload

Question 5

Conn’s syndrome is an endocrine cause of hypertension - what happens?

Answer 5

Excess production of aldosterone, leading to fluid overload

Question 6

What is Cushing’s syndrome?

Answer 6

Excess production of corticosteroid, usually cortisol

Question 7

What are the clinicopathological classifications of hypertension?

Answer 7

Benign

Malignant

Question 8

What is meant by benign hypertension?

Answer 8

Generally “asymptomatic” but this does not take away from the danger it poses and should be treated as aggressively as normal

Question 9

Every __ mm Hg above diastolic pressure of 85 mm Hg doubles the risk of an MI

Answer 9

10 mm Hg

Question 10

What blood vessel changes occur in hypertension?

Answer 10

Thickening of media (smooth muscle) layer

Arteriosclerosis (hardened arteries)

Question 11

Define malignant hypertension

Answer 11

Life-threatening condition where diastolic pressure greater than 130

Question 12

CVD mortality doubles with every __/__ mm Hg blood pressure increase

Answer 12

20/10 mm Hg

Question 13

Automated BP-measuring devices can still measure BP accurately even if the pulse is irregular. True/False?

Answer 13

False

Measure BP manually if pulse is irregular

Question 14

When considering a diagnosis of hypertension, does BP need to be measured in both arms?

Answer 14

Yes

Question 15

If clinic BP is measured at 140/90, what are the next steps?

Answer 15

Measure again: if different, measure 3rd time and use lowest reading as clinic BP
Then offer ABPM/HBPM to confirm diagnosis

Question 16

When using ABPM to confirm hypertension diagnosis, what must be ensured?

Answer 16

At least 2 measurements are take per hour during 14 hours;

Use average of these hours to diagnose hypertension (or not)

Question 17

When using HBPM to confirm hypertension diagnosis, what must be ensured?

Answer 17

Take 2 consecutive measurements while seated, 1 min apart;
Record twice daily for 4-7 days;
Discard 1st day measurements, use average of rest to diagnose hypertension (or not)

Question 18

Define Stage 1 hypertension

Answer 18

Clinic BP = 140/90+ ABPM/HBPM = 135/90

Question 19

Define Stage 2 hypertension

Answer 19

Clinic BP = 160/100+ ABPM/HBPM = 150/95

Question 20

Define Stage 3 (severe) hypertension

Answer 20

Clinic systolic BP = 180

ORClinic diastolic BP = 110

Question 21

For all hypertensive patients, which tests would you offer to better assess CVD risk?

Answer 21

Test urine (for protein)
Take bloods (glucose, electrolytes, creatinine)
Examine fundi (retinopathy)
Do an ECG

Question 22

What is hypertensive retinopathy?

Answer 22

Narrowing of retinal arterioles, increasing the risk of haemorrhage, hard exudates and papilloedema

Question 23

For patients under 80, what is the target BP in response to drug treatment?

Answer 23

Less than 140/90

Question 24

For patients over 80, what is the target BP in response to drug treatment?

Answer 24

Less than 150/90

Question 25

What is the drug treatment algorithm for hypertension?

Answer 25

If under 55: ACEi/ARB
If over 55 or Black: CaCB
---> + ACEi/ARB/CaCB
---> + Diuretic
---> + Further diuretic/Alpha/B blocker
---> + Spirinolactone
---> Refer to expert

Question 26

Which drug would you prescribe to a 54 year old with hypertension?

Answer 26

ACEi

Question 27

Which drug would you prescribe to a black guy with hypertension?

Answer 27

Ca++ blocker

Question 28

Which drug would you add onto a black guy already on an ACEi and Ca++ blocker whose hypertension is still not controlled?

Answer 28

Thiazide diuretic

Question 29

Treating hypertension is cheaper than doing nothing. True/False?

Answer 29

True, apparently

Question 30

Give some examples where “resistant hypertension” may occur

Answer 30

Non-concordance
White coat hypertension
Poor lifestyle
Secondary hypertension

Question 31

What are the two types of pulmonary hypertension?

Answer 31

Primary (rare) - increased BP with unknown secondary cause

Secondary - increased BP with known secondary cause

Question 32

What is cor pulmonale?

Answer 32

Right heart failure caused by chronic pulmonary arterial hypertension
Secondary to lung disease e.g. COPD

Question 33

In pregnancy, what are the potential complications of hypertension?

Answer 33

Preclampsia - hypertension + proteinuria

Eclampsia - seizures from increased BP