Hypertension

Question 1

What constitutes stage 1 HTN?

Answer 1

BP >= 140/90 mmHg in clinic and subsequent ABPM or HBPM >=135/85 mmHg

Question 2

What constitutes stage 2 HTN?

Answer 2

BP >= 160/100 mmHg in clinic and subsequent ABPM or HBPM >=150/90 mmHg

Question 3

What constitutes severe HTN?

Answer 3

Systolic BP >= 180 mmHg or diastolic BP >= 110 mmHg in clinic

Question 4

What constitutes accelerated HTN?

Answer 4

Clinic BP usually >= 180/110 with signs of papilloedema and/or retinal haemorrhage.

Question 5

Before the age of 65, is HTN more common in males or females?

Answer 5

Males

Question 6

After the age of 65, is HTN more common in males or females?

Answer 6

Females

Question 7

What is the increased percentage risk of IHD for every 2mmHg rise in BP?

Answer 7

7%

Question 8

What percentage of HTN is primary HTN (no identifiable cause)?

Answer 8

90%

Question 9

What drop in mmHg between clinic and home BP monitoring is sufficient to suggest a ‘white coat’ effect?

Answer 9

Drop of >= 20mmHg in SBP

Drop of >= 10mmHg in DBP

Question 10

What signs indicate hypertensive retinopathy from fundoscopy?

Answer 10

Silver copper wiring, AV nipping, flame haemorrhages, cotton wool spots.

Question 11

What things should be covered in the annual HTN review?

Answer 11

BP, , any symptoms, signs of end-organ damage/failure (eyes, heart, kidneys, liver, etc.), medication r/v including adherence and side effects, depression screen, check HbA1c and cholesterol, assess lifestyle risk factors (diet, exercise, weight, alcohol, smoking, stress).

Question 12

When should anti-hypertensive medication be offered to patients?

Answer 12

If patient is under 80 and has stage 1 HTN AND at least one of: target organ damage, established CVD, renal disease, diabetes, Qrisk2 >= 20%.
Any patient with stage 2 or above HTN

Question 13

What class of drug should be offered to white patients under 55 for HTN?

Answer 13

ACE inhibitor (e.g. ramipril)
or, if can't tolerate dry cough, ARB.

Question 14

What class of drug should be offered to over 55s or black patients of any age for HTN?

Answer 14

Calcium channel blocker (e.g. amlodipine)

Question 15

What drug can be added if the first intensification of an ACE-inhibitor and CCB is not sufficient in controlling BP?

Answer 15

Thiazide-like diuretics (e.g. Indapamide)

Question 16

When should patients be followed up if started on an ACE-inhibitor?

Answer 16

Check U&Es 2 weeks after initiating ACE-i then review BP after 4 weeks to see effect. If increasing the dose of ACE-i, re-check renal function and BP after 4 weeks

Question 17

When should patients be followed up if started on a CCB?

Answer 17

Check BP after 4 weeks

Monitor S/E of ankle swelling, dizziness, headaches, nausea

Question 18

What are the key side effects of diuretics?

Answer 18

Increased urine output and gout

Question 19

What is the HTN treatment target for under 80s?

Answer 19

< 140/90 mmHg

Question 20

What is the HTN treatment target for over 80s?

Answer 20

< 150/90 mmHg

Question 21

What is the HTN treatment target for diabetic patients with renal/foot/eye/CV complications?

Answer 21

< 130/80 mmHg

Question 22

What is the HTN treatment target for CKD?

Answer 22

< 130/80 mmHg