Hypertension

Question 1

what is hypertension?

Answer 1

= high blood pressure

the level of blood pressure where treatment does more good than harm

Question 2

when should blood pressure be measured?

Answer 2

• in a relaxed temperature setting

- person quiet and seated

Question 3

in people with symptoms of postural hypotension, how should you measure blood pressure?

Answer 3

• measure blood pressure with the person supine or seated

- measure blood pressure again with the person standing for at least 1 minute prior to measurement

Question 4

what are the 2 ways hypertension can be measured?

Answer 4

1) home BP
2) ABPM
(ambulatory blood pressure monitor)

Question 5

when using the ABPM machine, when should the measurements be taken?

Answer 5

= at least 2 measurements per hour during the persons usual waking hours (usually 14/day)

Question 6

when using the HBPM machine, when should the measurements be done and how?

Answer 6

= two consecutive seated measurements, 1 minute apart

• BP recorded 2x a day for at least 4 days & preferably 7 days.
• measurements are discarded on first day & the average value of all remaining are used

Question 7

in the white coat hypertension, who is at the greatest risk factor?

Answer 7

• older female
• smoker
• high clinical SBP (systolic blood pressure)
• variable daytime readings

Question 8

what is the blood pressure for stage 1 hypertension?

Answer 8

= BP of 140/90mmHg or higher
AND
= ABPM or HBPM daytime average of 135/85mmHg or higher

Question 9

what is the blood pressure for stage 2 hypertension?

Answer 9

= BP of 160/100mmHg or higher
AND
= ABPM or HBPM daytime average of 150/95mmHg or higher

Question 10

what is the blood pressure for severe hypertension?

Answer 10

= BP of 180mmHg or higher OR

= diastolic BP of 110mmHg or higher

Question 11

for people with hypertension, what should you offer to measure?

Answer 11

1) test urine for present of protein
2) take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate & cholesterol
3) examine fundi for hypertensive retinopathy
4) arrange a 12 lead ECG

Question 12

what is the main driver of absolute risk for hypertension?

Answer 12

age

Question 13

what is another risk factor for hypertension?

Answer 13

= end organ damage

Question 14

give 4 examples of end organ damage, that is a risk factor for hypertension?

Answer 14

1) left ventricular hypertrophy
2) creatinine raised
3) albuminuria/microalbuminnuria
4) retinopathy

Question 15

what are 4 established diseases that act as a risk factor for hypertension?

Answer 15

1) ischaemic heart disease
2) cerbro-vascular disease
3) peripheral vascular disease
4) diabetes

Question 16

what is hypertensive retinopathy?

Answer 16

retinal vascular damage caused by hypertension.

Question 17

what are 4 signs to look out for in hypertensive retinopathy?

Answer 17

1) flame heamorrhage
2) papilloedema
3) cotton wool spot
4) hard exudate

Question 18

what should people under the age of 55 be treated with?

Answer 18

= step 1 anti-hypersensitive treatment
- with an angiotensin-converting enzyme (ACE) inhibitor
OR
- low cost angiotensin II receptor blocker (ARB)

Question 19

in hypertension, what should NOT be combined?

Answer 19

• ACE inhibitor with an ARB

Question 20

what should people over the age of 55 and black people of African or Caribbean origin of any age be treated with?

Answer 20

= step 1 anti-hypersensitive treatment

- calcium channel blockers (CCB)

Question 21

if there is any risk of heart failure or risk of heart failure, what should be given?

Answer 21

= thiazide like diuretic

Question 22

if blood pressure is not controlled by step 1 treatment, what should be done?

Answer 22

• offer step 2 treatment with a CCB in combination with either ACE inhibitor or an ARB.

Question 23

for people undergoing drug treatment what is the blood pressure target for people under age of 80 and people over age of 80?

Answer 23

Under 80
= 140/90mmHg

80 & over
= 150/90mmHg

Question 24

for people with the white-coat effect undergoing treatment, what is the aim target for ABPM/HBPM in people over the age of 80 and under the age of 80?

Answer 24

Under 80
= below 135/85mmHg

Aged 80 & over
= below 145/85mmHg

Question 25

what do twin studies show?

Answer 25

show 30-50% of BP variability which is genetically determined

Question 26

what are the common diseases associated with secondary hypertension?

Answer 26

1) renal disease
2) obstructive sleep apnoea
3) aldosteronism
4) reno-vascular disease

Question 27

what are the uncommon diseases associated with secondary hypertension?

Answer 27

1) cushing’s
2) pheochromocytoma
3) hyperparathyroidism
4) aortic coarctation
5) intracranial tumour

Question 28

in hypersensitive patients, what do the majority if patients have an inappropriate secretion of?

Answer 28

= inappropriate secretion of aldosterone