Hypertension

Question 1

What is stage 1 HTN?

Answer 1

Clinic BP >140/90

ABPM >135/85

Question 2

Stage 2?

Answer 2

Clinic BP >160/100

ABPM >150/95

Question 3

Severe?

Answer 3

Clinic systolic >180 or diastolic >120

Question 4

Accelerated?

Answer 4

Clinic BP >180/110

Signs of papilloedema/ retinal haemorrhage

Question 5

How is stage 1 managed?

Answer 5

Lifestyle advice + review

Question 6

When should antihypertensive medication be offered?

Answer 6

Stage 2 HTN

Question 7

What is the management for accelerated HTN?

Answer 7

Same day specialist referral

Question 8

Explain ABPM to a patient

Answer 8

Worn all day (24 hours), readings through out the day. Can still drive, go to work etc
Measurements every 2 hours

Question 9

HBMP

Answer 9

Readings twice a day, self-recorded

Question 10

What does HTN increase the risk of?

Answer 10

HF, stroke, CHD, PVD, vascular dementia, CKD

Question 11

What is QRISK2?

Answer 11

Estimation of 10 year risk of CHD

>20% is high risk

Question 12

What QRISK score should you start someone on a statin?

Answer 12

> 20%

Consider if >10%

Question 13

What else would you investigate in stage 1 HTN?

Answer 13

Serum cholesterol + HDL cholesterol

Question 14

If the patient is <40 years what do you need to investigate for?

Answer 14

SECONDARY CAUSES IF UNDER 40 YEARS + end-organ damage

Question 15

When should anti-hypertensives be offered? (think other problems)

Answer 15

End organ damage
Established CVD
Renal disease
Diabetes
QRISK >20%

Question 16

If a patient is <55 years, what is first line?

Answer 16

ACEi (ramipril)

Question 17

When should a patient take the first ramipril?

Answer 17

At night - can cause drastic hypotension

Question 18

What is a contraindication of ramipril?

Answer 18

Renal artery stenosis

Question 19

What is first line if patient is black/ >55?

Answer 19

CCB
e.g. amlodipine
once daily

Question 20

CCB: what SEs should you warn about?

Answer 20

Swollen ankles, headaches, nausea

Question 21

Give 2 other examples of CCBs

Answer 21

Diltiazem

Nifedipine

Question 22

How do CCBs work?

Answer 22

Cause relaxation + vasodilation in arterial smooth muscle

Question 23

What is an alternative if ACEi not tolerated?

Answer 23

ARB

e.g. losartan

Question 24

If 1st line is not effective what is the next step?

Answer 24

Combine treatments (ACEi + CCB)

Question 25

A patient is on ramipril and amlodipine at max doses but still hypertensive. What is the next step?

Answer 25

Review compliance Add a thiazide e.g. bendroflumethiazide

Question 26

What are other further add ons for HTN?

Answer 26

Spironalactone Higher dose of thiazide Alpha blocker Beta blocker

Question 27

What should be monitored in a patient on spironalactone

Answer 27

potassium levels (if <4.5)

Question 28

What type of drug is doxazosin?

Answer 28

Alpha blocker

Question 29

What are SEs of alpha blockers? | hint: postural hypotension is a contraI

Answer 29

Postural hypotension Dizziness Syncope

Question 30

What is the target BP for someone >80 years?

Answer 30

150/90

Question 31

Once BP is well-controlled how often should patients be reviewed?

Answer 31

Annually

Question 32

LVH, proteinuria + albuminuria are examples of ?

Answer 32

End-organ damage

Question 33

What medications can cause HTN?

Answer 33

Steroids NSAIDs Sympathomimetics Venlafaxine (anti-D)