Hypertension

Question 1

Definitions for each stage of hypertension

Answer 1

Stage 1 = >140 / >90

Stage 2 = >160 / >100

Stage 3 = >180 / >110

Accelerated HTN = >180/110 + papilloedema/retinal haemorrhages

Question 2

Investigations in diagnosis of HTN

Answer 2

BP + 24hr ABPM to confirm
ECG
Bloods - cholesterol, TFTs, fasting metabolic panel
Urinalysis - ACR - for end organ damage, dipstick for proteinuria, eGFR

Question 3

Principles of lifestyle modification advice

Answer 3

Sodium intake reduction, potassium supplementation (unless CKD)
Dietary modification + improvement
Waist circumference <102 (M) / <88cm (F)
BMI ~25
150 mins/week intense exercise
Limit alcohol + smoking cessation

Question 4

Starting medication in a Stage 1 hypertensive, <55yrs, Caucasian

Answer 4

ACEi - Ramipril - 2.5mg, PO, OD

if not tolerated –> ARB
Losartan/Valsartan - 50mg, PO, OD

Question 5

Initial medication in stage 1 hypertensive, aged >55yrs, or any age of Afro-Caribbean descent

Answer 5

CCB - Amlodipine, 5mg, PO, OD

Question 6

Step 2 in hypertension treatment ladder

Answer 6

ACEi/ARB + CCB

Question 7

Step 3 in hypertension treatment ladder

Answer 7

ACEi/ARB + CCB + Thiazide like diuretic

e.g. Indapamide - 1.25mg, PO, OD

Question 8

Step 4 - resistant hypertension

Answer 8

If K+ Low (<4.5mmol/L) - add K+ sparing agent
–> Spironolactone

If K+ >4.5mmol/L - increase TZD dosage

Question 9

Plan for resistant hypertension resistant to treatment ladder?

Answer 9

Check adherence

Consider alpha/beta blocker
NB - Beta blocker CI in HR <70bpm

Question 10

How frequently should BP be monitored in HTN

Answer 10

While adjusting dose - monitor BP every 2-4 weeks

Once stabilised - every 6-12 months

Question 11

What is included in HTN annual review

Answer 11

Lifestyle, symptoms, medication (adherence)

Check clinic BP –> ABPM if raised

Check renal function annually: serum creatinine, electrolytes, eGFR, dipstick (proteinuria)
Calculate QRISK and advise on statins