Hypertension

Question 1

What is stage 1 HTN

Answer 1

140/90 or higher
AND
ABPM/HBPM 135/90 or higher

Question 2

What is stage 2 HTN

Answer 2

160/100 or higher
AND
ABPM/HBPM 150/95 or higher

Question 3

What is severe HTN

Answer 3

Systolic 180 or higher
OR
diastolic 110 or higher

Question 4

What are neuro complications of HTN

Answer 4

cerebral oedema

brain haemorrhage

Question 5

What are renal complication of HTN

Answer 5

haematuria
proteinuria
progressive kidney disease

Question 6

What are signs of retinal damage from HTN

Answer 6

flame shaped haemorrhages
cotton wool spots
papilloedema

Question 7

What conditions does HTN increase the risk of getting?

Answer 7

Heart failure.
Coronary artery disease.
Stroke.
Chronic kidney disease.
Peripheral arterial disease.
Vascular dementia.

Question 8

What is usually found on examination in HTN?

Answer 8

usually just raised BP

usually asymptomatic

Question 9

What ix should be undertaken? explain why

Answer 9

Serum U&Es/eGFR - assess renal function
Urine six - proteinuria and haematuria
Blood glucose - assess for DM
Serum lipids and cholesterol - risk of coronary events
ECG -LV hypertrophy or myocardial ischaemia

Question 10

What is step 1 treatment?

Answer 10

1. Offer ACEi (ramipril)
   If not tolerated offer ARB (losartan)
2. If >55 or Afro/Caribbean black - offer CCB (amlodipine) or TLD (imapramade) if CCB not suitable

Question 11

When should beta-blockers be offered as step 1 treatment?

Answer 11

in younger people if:
have intolerance or CI to ACEi/ARB
women of child bearing potential
increased sympathetic drive

Question 12

What is step 2 treatment?

Answer 12

Offer CCB in combination w ACEi/ARB
If CCB contraindicated - TLD
For black(afro/caribbean) - add ARB

Question 13

What is step 3 treatment?

Answer 13

ACEi/ARB + CCB + TLD

Question 14

What is step 4 treatment? What type of HTN is this classified as if they get to this point?

Answer 14

Resistant HTN
Add spironolactone
If CI, add high dose TLD
Consider alpha/beta blocker if further therapy needed

Question 15

Why may spironolactone be contraindicated?

Answer 15

if blood K+ higher than 4.5mmol/l or reduced eGFR due to risk of hyperkalaemia

Question 16

How should diuretic therapy be monitored?

Answer 16

na+, K+ and U+Es/eGFR

Question 17

When should anti-hypertensives be offered?

Answer 17

if <80 w stage 1 HTN + one or more of the following:
target organ damage
established CV disease
Renal disease
DM
10 yr CV risk 20% or more 
ORRRRRRR
Stage 2 HTN any age

Question 18

What is essential HTN?

Answer 18

no underlying cause w multifactorial aetiology

Question 19

What is secondary HTN?what can it be due to?

Answer 19

• result of specific condition e.g. renal disease, endocrine disease, coarctation of the aorta, preeclampsia, drugs (COCP, steroids, NSAIDs, vasopressin)