Hypertension

Question 1

What is hypertension?

Answer 1

Clinic blood pressure >140/90mmHg.

Question 2

What is essential hypertension?

Answer 2

Hypertension with no known cause- 95% of cases.

Question 3

What is secondary hypertension?

Answer 3

This should be considered in young patients with an acute onset of hypertension, any history suggestive of a renal or endocrine cause, and when he patient fails to respond to medical therapy.
Examples include: reno vascular disease, Conn’s syndrome, Cushing’s disease and phaeochromocytoma.

Question 4

How is blood pressure controlled by the body?

Answer 4

Several mechanisms: the autonomic nervous system, the capillary fluid shift mechanism, the renin angiotensin aldosterone system and adrenaline. A problem with one of these mechanisms may result in high blood pressure.

Question 5

What factors may play a role in increasing blood pressure?

Answer 5

Lifestyle factors such as smoking, alcohol intake, obesity and stress.

Question 6

What are the causes of hypertension?

Answer 6

Unknown: essential hypertension.
Secondary causes: renal and endocrine disease.
Contributory lifestyle factors such as increased stress, smoking and obesity.

Question 7

What are the complications of hypertension?

Answer 7

Myocardial infarction.
Heart failure.
Renal impairment.
Stroke.
Hypertensive retinopathy.

Question 8

What investigations should be performed for hypertension?

Answer 8

Clinic blood pressure readings (with ambulatory blood pressure monitoring to confirm).
Bloods: FBC, U&Es, LFTs, creatinine, serum urea, cGFR, lipid levels and glucose.
ECG: left ventricular hypertrophy.
Urine dipstick: haematuria and proteinuria.

Question 9

What is the conservative treatment for hypertension?

Answer 9

Lifestyle advice including smoking cessation, encouraging weight loss, decreased alcohol consumption and a salt restricted diet.

Question 10

What is step 1 of the medical treatment for hypertension in patients <55 years old?

Answer 10

ACE inhibitor or angiotensin receptor blocker (ARB) if ACEi not tolerated by patient.

Question 11

What is step 2 of the medical treatment for hypertension?

Answer 11

ACEi/ARB and calcium channel blocker, or

ACEi/ARB and thiazide diuretic.

Question 12

What is step 3 of the medical treatment for hypertension?

Answer 12

ACEi or ARB and calcium channel blocker and thiazide diuretic.

Question 13

What is step 4 of the medical treatment for hypertension?

Answer 13

Refer for add-on therapy: spironolactone (side effect: hyperkalaemia), alpha blocker or beta blocker.

Question 14

What is step 1 of the medical treatment for hypertension in patients >55 years old/ black patients?

Answer 14

Calcium channel blocker or thiazide diuretic.

Question 15

What is the surgical treatment for hypertension?

Answer 15

Surgical excision (if related to cause).

Question 16

What does angiotensin II stimulate?

Answer 16

Aldosterone secretion from zona glomerulosa of adrenal cortex.
Vasoconstriction.
Antidiuretic hormone (ADH) release from posterior pituitary gland.
Sympathetic nervous system.