Hypertension

Question 1

Complication of hypertension:

Answer 1

Kidney - Renal disease, dialysis, protein in the urine
Heart- MI, left ventricular hypertrophy, coronary heart disease
Brain - Stroke, haemorrhage
Eye - Retinopathy
Vasculature - Peripheral vascular disease

Question 2

What types of stress cause BP to fluctuate during the day?

Answer 2

Physical and mental

Question 3

A small increase in BP increases the risk of what conditions?

Answer 3

Stroke and cardiovascular disease (heart attack)

Question 4

According to the BHS, what blood pressure is considered hypertensive?

Answer 4

140/90 mm Hg

Question 5

Define stage 1 hypertension clinically

Answer 5

140/90 or higher

Question 6

Define stage 2 hypertension clinically

Answer 6

160/100 or higher

Question 7

Define severe hypertension clinically

Answer 7

180 systolic or higher OR 110 diastolic or higher

Question 8

Primary hypertension:

Answer 8

No known cause (95%)

Question 9

Secondary hypertension causes:

Answer 9

Chronic renal disease, renal artery stenosis, endocrine conditions (Cushing’s syndrome, Conn’s syndrome, acromegaly)

Question 10

Risk factors have hypertension:

Answer 10

• Cigarette smoking
• Diabetes mellitus
• Renal disease
• If you are male
• Hyperlipidaemia
• Previous MI or stroke
• Left ventricular hypertrophy

Question 11

Prime contributors to blood pressure:

Answer 11

Cardiac output (stroke volume, heart rate) and peripheral vascular resistance

Question 12

Activation of the sympathetic nervous system produces:

Answer 12

• Vasconstriction
• Reflex tachycardia
• Increased cardiac output
  (In this way, blood pressure is increased)

Question 13

What does renin do?

Answer 13

Converts angiotensinogen to angiotensin I

Question 14

What does renin do?

Answer 14

Converts angiotensinogen to angiotensin I and causes water retention in the kidneys

Question 15

What does angiotensin converting enzyme (ACE) do?

Answer 15

Converts angiotensin I to angiotensin II

Question 16

What does angiotensin II do?

Answer 16

It is a potent hypertrophic agent which stimulates myocyte and smooth muscle hypertrophy in the arterioles

Question 17

Describe the aetiology of hypertension

Answer 17

• Polygenic
• Polyfactorial
• Age
• Genetics and family history
• Environment
• Weight
• Alcohol intake
• Ethnicity
• Salt intake and diet

Question 18

Causes for secondary hypertension which are drug induced:

Answer 18

• NSAIDs
• Oral contraceptive
• Corticosteroids

Question 19

Other causes of secondary hypertension (not already mentioned):

Answer 19

Narrowing of the aorta, pregnancy and sleep apnoea

Question 20

Symptoms of hypertension:

Answer 20

• Syncope
• Tinnitus
• Usually asymptomatic
• Flushed
• Fatigue
• Blurred vision

Question 21

How do we first confirm the diagnosis of hypertension?

Answer 21

ABPM - Ambulatory blood pressure monitoring (more common)

HBPM - Home blood pressure monitoring

Question 22

How else do we diagnose hypertension?

Answer 22

• Assess the risk (look at the risk factors)
• Access end organ end damage (ECG, echocardiogram, renal ultrasound, proteinuria etc)
• Screen for treatable causes (renal artery stenosis, cushings, conn’s and sleep apnoea)

Question 23

BHS taget pressure:

Answer 23

< 135/80-85 mm Hg

Question 24

Why do we treat hypertension?

Answer 24

• Reduce MI

- Reduce cerebrovascular disease

Question 25

How do we treat hypertension?

Answer 25

• Look for and treat the underlying cause
• Stepped approach (add medications to current therapies until the target BP is achieved)
• Use low doses of several drugs
  (this approach minimises adverse events and maximises patient compliance)

Question 26

According to the BHS guidelines, what drugs should be used for different age groups?

Answer 26

• ACE inhibitor for young people because they have a lot of renin (< 55 years)
• Calcium channel blocker and thiazide for old people as they have little renin (>=55 years)

Question 27

Step 1 treatment for hypertension:

Answer 27

• If the patient is >= 55 years old or is black African/Caribbean, 1st choice is a calcium channel blocker. If CCB not suitable (oedema, intolerance, heart failure) then offer thiazide like diuretic.
• If the patient is <55, and is not African/Caribbean and is not a women of child baring age, then offer ACE inhibitor/Angiotensin II receptor blocker

Question 28

Step 2 treatment for hypertension:

Answer 28

Add thiazide type diuretic such as chlortalidone or indapamide to CCB or ACEI/ARB

Question 29

Ramipril:

Answer 29

• Angiotensin converting enzyme inhibitor (ACEI)