Hypertension

Question 1

What is stage 1 hypertension
What is stage 2
What is severe hypertension

Answer 1

Stage 1 hypertension Clinic blood pressure is 140/90 mmHg or higher and subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher.

Stage 2 hypertension Clinic blood pressure is 160/100 mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher.

Severe hypertension Clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic blood pressure is 110 mmHg or higher.

Question 2

Step 1 treatment for hypertension for ppl under 55

If not tolerated due to cough etc offer…

Answer 2

Offer people aged under 55 years step 1 antihypertensive treatment with an angiotensin-converting enzyme (ACE) inhibitor or a low-cost angiotensin-II receptor blocker (ARB). If an ACE inhibitor is prescribed and is not tolerated (for example, because of cough), offer a low-cost ARB.

Question 3

Step 1 for people over 55 or afro Caribbean

Answer 3

1.6.6 Offer people aged under 55 years step 1 antihypertensive treatment with an angiotensin-converting enzyme (ACE) inhibitor or a low-cost angiotensin-II receptor blocker (ARB). If an ACE inhibitor is prescribed and is not tolerated (for example, because of cough), offer a low-cost ARB.[6][2011]

Question 4

Step 2 treatment

Answer 4

Step 2 treatment

1.6.13 If blood pressure is not controlled by step 1 treatment, offer step 2 treatment with a CCB in combination with either an ACE inhibitor or an ARB.

Question 5

Under 50 which pressure more likely to be elevated

Over 50 “ why?

Answer 5

Diastolic pressure is more commonly elevated in people younger than 50. With ageing, systolic hypertension becomes a more significant problem, as a result of progressive stiffening and loss of compliance of larger arteries. At least one quarter of adults (and more than half of those older than 60) have high blood pressure.

Question 6

Step 3

Ca blocker ace-I and

Answer 6

A thiazide like diuretic

Question 7

Secondary hypertension is caused by

Answer 7

Secondary hypertension: ~5% of cases. Causes include:
• Renal disease: the most common secondary cause. 75% are from intrinsic renal
disease: glomerulonephritis, polyarteritis nodosa (PAN), systemic sclerosis, chronic pyelonephritis, or polycystic kidneys. 25% are due to renovascular disease, most frequently atheromatous (elderly  cigarette smokers, eg with peripheral vascular disease) or rarely fibromuscular dysplasia (young ).
• Endocrine disease: Cushing’s ) and Conn’s syndromes phaeochromo- cytoma (), acromegaly, hyperparathyroidism.
• Others: coarctation pregnancy (OHCS liquorice, drugs: steroids, MAOI, oral contraceptive pill, cocaine, amphetamines.

Question 8

What is malignant hypertension

What are symptoms

Answer 8

Malignant’ or accelerated phase hypertension: A rapid rise in BP leading to vas- cular damage (pathological hallmark is fibrinoid necrosis). Usually there is severe hypertension (eg systolic >200, diastolic>130mmHg) + bilateral retinal haemorrhages and exudates; papilloedema may or may not be present. Symptoms are common, eg headache ± visual disturbance. It requires urgent treatment, and may also pre- cipitate acute kidney injury, heart failure, or encephalopathy, which are hypertensive emergencies. Untreated, 90% die in 1yr; treated, 70% survive 5yrs. It is more com- mon in younger and in black subjects. Look hard for any underlying cause.

Question 9

White coat hypertension

Answer 9

White-coat hypertension Refers to an elevated clinic pressure, but normal ABPM (day average <135/85). NICE says don’t treat; but more likely to develop hypertension in future, and may have risk of CVD. Masked hypertension is the opposite.

Question 10

How do you diagnose hypertension

Answer 10

Tests To confirm diagnosis: ABPM or home BP monitoring. To help quantify overall risk: Fasting glucose; cholesterol. To look for end-organ damage: ECG or echo (any LV hypertrophy? past MI?); urine analysis (protein, blood). To ‘exclude’ secondary causes: U&E (eg K+ decrease in Conn’s); Ca2+ ( in hyperparathyroidism). Special tests: Re- nal ultrasound/arteriography (renal artery stenosis); 24h urinary meta-adrenaline urinary free cortisol (p225); renin; aldosterone; MR aorta (coarctation).