Hypertension

Question 1

What are the secondary causes of hypertension?

Answer 1

‘ROPE’

Renal disease
Obesity
Pregnancy/Pre-Eclampsia
Endocrine (e.g. hyperaldosteronism)

Question 2

What BP do you need to have for a diagnosis of Stage 1 and Stage 2 Hypertension?

Answer 2

Stage 1: 140/90 (135/85)

Stage 2: 160/100 (150/95)

Question 3

In patients with Stage 1 Hypertension, what is the treatment?

Answer 3

First do ABPM, calculate CV risk and look for end organ damage

If BP is >135/85, treat if patients <80 AND any of the following:

Target organ damage
Cardiovascular disease
Diabetes
Renal disease
QRISK >20%

Question 4

How would you instruct a patient to do an ABPM?

Answer 4

Two measurements per hour from 8am to 10pm

Take an average reading of 14 measurements

Question 5

In a newly diagnosed hypertensive patient, what investigations should be done?

Answer 5

Fundoscopy
Urine dipstick
ECG
HbA1c

Question 6

What is the grading of hypertensive retinopathy?

Answer 6

1) Tortuous arteries with silver or copper wiring
2) AV nipping
3) Flame haemorrhages and cotton wool spots
4) Papilloedema

Question 7

If a patient is >55 or black of any age, what is the Step 1 treatment of their hypertension?

If a patient is <55, what is the Step 1 treatment of their hypertension?

Answer 7

Either CCB or thiazide diuretic

First choice is ACE-i.

Question 8

What are Steps 2, 3 & 4 management of hypertension?

Answer 8

Step 2: A + C
Step 3: A + C + D
Step 4: If K+ <4.5 add spironolactone
If K+ >4.5 add spironolactone

Question 9

What are the side effects of ACE inhibitors?

Answer 9

Dry cough
Angioedema
Hyperkalaemia

Check renal function 2-3 weeks after starting

Question 10

What are the side effects of CCB’s?

Answer 10

Flushing
Ankle swelling
Headache

Question 11

What is the mechanism of action of Thiazide Like Diuretics and what are the side effects?

Answer 11

Inhibit sodium resorption at the beginning of the DCT

SE: hyponatraemia, hypokalaemia, dehydration

Question 12

What metabolic abnormality can Angiotensin II receptor blockers cause? What are the other SE of the drug class?

Answer 12

Hyperkalaemia

SE: vertigo, uritcaria, pruritis

Question 13

If a patient presents with hypokalaemia and hypertension, what are the most likely diagnoses?

Answer 13

Cushing’s syndrome
Conn’s syndrome
Liddle’s syndrome

Question 14

What is the first line treatment of hypertension in diabetic patients?
What about in black diabetic patients?
What about in young women with child bearing potential?

Answer 14

ACEi
ACEi and CCB
CCB

Question 15

What is a CI to the use of thiazide diuretics?

Answer 15

Gout

Question 16

What are examples of hypertensive emergencies and what is the treatment?

Answer 16

Malignant or accelerated hypertension
Associations with encephalopathy, aortic dissection or other end organ damage

Reduce BP by 20% in first hour and IV labetalol or hydralazine is often used

If there is severe hypertension without end organ damage this is called hypertensive urgency and usually give PO labetalol or amlodipine