Hypertension

Question 1

What is the NICE definition of Stage 1 Hypertension?

Answer 1

Clinic reading: 140/90 mmHg

ABPM reading: 135/85 mmHg

Question 2

What is the NICE definition of Stage 2 Hypertension

Answer 2

Clinic reading: 160/100 mmHg

ABPM reading: 150/95 mmHg

Question 3

When do you decide to treat Stage 1 Hypertension with medication?

Answer 3

Only treat if they are <80 years old, with organ damage or a QRISK >20%

Question 4

When do you decide to treat Stage 2 Hypertension with medication?

Answer 4

Always treat with medication

Question 5

A diabetic who is 67 year old is diagnosed with Stage 1 Hypertension. What is first-line medication?

Answer 5

ACEI

Question 6

What is the 1st, 2nd, 3rd, 4th and 5th line treatments for a patient under 55 with Stage 1 HTN?

Answer 6

1. ACEI or ARB
2. ACEI / ARB + CCB or ACEI / ARB + Thiazide
3. ACEI / ARB + CCB + Thiazide
4. Add Spirinolactone (if K<4.5) or Alpha / Beta Blocker (if K>4.5)
5. If BP not controlled on 4 drugs, then specialist review

Question 7

What is the NICE definition for Severe Hypertension?

Answer 7

Systolic >180 mmHg or Diastolic >110 mmHg

Question 8

What are Blood Pressure targets for <80 year old patients and >80 year old patients?

Answer 8

<80 year olds: 140/90 mmHg (Clinic)
<80 year olds: 135/85 mmHg (ABPM)

> 80 year olds: 150/90 mmHg (Clinic)
80 year olds: 145/85 mmHg (ABPM)

Question 9

State four secondary renal causes of HTN

Answer 9

• Adult PKD
• Glomerulonephritis
• Chronic pyelonephritis
• Renal artery stenosis

Question 10

State six secondary endocrine causes of HTN

Answer 10

• Primary hyperaldosteronism
• Phaochromocytoma
• Cushing’s disease
• Acromegaly
• Liddle’s syndrome
• Congenital adrenal hyperplasia

Question 11

State three medications which can cause HTN

Answer 11

• COCP
• Glucocorticoids
• NSAIDs

Question 12

Which heart condition is a secondary cause of HTN?

Answer 12

Coarctation of the Aorta

Question 13

What test must be performed 2-3 weeks after initiating ACEI for HTN?

Answer 13

Renal function tests i.e. U&Es

Question 14

Metabolic syndrome is a term to describe what?

Answer 14

A triad of Diabetes, High blood pressure and Obesity

Question 15

After checking someone’s blood pressure, what other tests may be of value in a patient with hypertension?

Answer 15

Urine dipstick / FBC: For electrolyte abnormalities / renal function / cholesterol 
Fundoscopy: For hypertensive retinopathy
ECG: For LVH / Ischaemic heart disease
HbA1c: For diabetes
Lipids: For hyperlipidaemia

Question 16

Which anti-depressant medication can cause hypertension?

Answer 16

Venlafaxine (SNRI)

Question 17

What are the side effects associated with ACEI?

Answer 17

Cough
Angio-oedema
Hyperkalaemia

Question 18

What are the side effects associated with CCBs?

Answer 18

Flushing
Ankle swelling
Headaches

Question 19

What electrolyte abnormalities are associated with Thiazides?

Answer 19

Hyponatraemia

Hypokalaemia

Question 20

What electrolyte abnormalities are associated with ARBs?

Answer 20

Hyperkalaemia

Question 21

1. What is Malignant hypertension?
2. What are some signs and symptoms?
3. What is the diagnostic criteria?

Answer 21

1. A hypertensive emergency, where BP is extremely high and there is life threatening symptoms indicating acute impairment of 1< organ systems
2. Papillo-oedema, retinal bleeding, raised ICP so headaches and nausea, chest pain, haematuria, nosebleeds which are difficult to stop
3. Diagnosed by a systolic >180 or diastolic >120 plus evidence of acute organ damage

Question 22

1. What is Orthostatic Hypotension defined as?
2. What are some risk factors of Orthostatic Hypertension?
3. What is the management

Answer 22

1. Drop in 20/10 mmHg within 3 mins
2. Older patients, diabetes, HTN, neurodegenerative (Parkinson’s), Iatrogenic (alpha blocker for BPH)
3. Midodrine, Fludrocortisone