Hypertension

Question 1

Hypertension?

Answer 1

Systolic >140 mm Hg and/or diastolic >90 mm Hg measured on 3 separate occasions.

Question 2

Hypertension systole and diastole?

Answer 2

Question 3

Hypertension malignant hypertension?

Answer 3

BP > 200/130mm Hg

Question 4

Hypertension risk factors (5)?

Answer 4

Primary or idiopathic hypertension, responsible for >90% of cases.

Secondary Renal

Secondary endocrine

Secondary cardiovascular

Secondary to pregnancy.

Question 5

Hypertension risk factors secondary renal (5)?

Answer 5

renal artery stenosis,

chronic glomerulonephritis,

chronic pyelonephritis,

polycystic kidney disease,

chronic renal failure.

Question 6

Hypertension risk factors secondary endocrine (8)?

Answer 6

DM,

hyperthyroidism,

cushings syndrome,

Conns syndrome,

hyperparathyroidism,

phaeochromocytoma,

congenital adrenal hyperplasia,

acromegaly.

Question 7

Hypertension risk factors secondary cardiovascular (2)?

Answer 7

coarctation of the aorta,

increased intravascular volume.

Question 8

Hypertension risk factors secondary to drugs (3)?

Answer 8

sympathomimetics,

corticosteroids,

COCP.

Question 9

Hypertension epidemiology?

Answer 9

very common

10-20% of western adults

Question 10

Hypertension symptoms?

Answer 10

Often asymptomatic, but symptoms of cause or complications.

Symptoms of malignant hypertension; scotomas, blurred vision, headache, seizures, nausea and vomiting, acute heart failure

Question 11

Hypertension signs?

Answer 11

Radiofemoral delay = coarctation of the aorta distal to the left subclavian artery.

Renal artery bruit = renal artery stenosis. (swishing sound)

Fundoscopy to detect hypertensive retinopathy.

Question 12

Hypertension investigations (3)?

Answer 12

bloods (U&Es, glucose, lipids)

urine dipstick (blood and protein)

ECG (may show left ventricular hypertrophy or ischaemia)

Question 13

Hypertension management conservative (4)?

Answer 13

stop smoking,

lose weight,

reduce alcohol intake,

reduce dietary sodium.

Question 14

Hypertension management medical?

Answer 14

for systolic >160mm Hg or diastolic >100mm Hg;

ACE inhibitors or angiotensin receptor blockers (for >55, DM, heart failure, left ventricle dysfunction),

CCBs (>55, black),

Beta blockers, alpha blockers (4th line treatment).

For severe hypertension management; atenolol and nifedipine.

Question 15

Hypertension management for acute malignant hypertension?

Answer 15

IV beta blocker, labetolol, hydralazine sodium nitroprusside.

Question 16

Hypertension target BP?

Answer 16

non-diabetic <140/90 mm Hg,

diabetes without proteinuria <130/80 mm Hg,

diabetes with proteinuria <125/75

Question 17

Hypertension complications (9)?

Answer 17

Heart failure, coronary artery disease, cerebrovascular disease, peripheral vascular disease, emboli, hypertensive retinopathy, renal failure, hypertensive encephalopathy, malignant hypertension