Hypertension

Question 1

What is stage 1 hypertension?

Answer 1

Clinical blood pressure is 140/90mmHg or higher and ABPM, daytime average, HBPM average is 135/85mmHg or higher

Question 2

What is stage 2 hypertension?

Answer 2

Clinic BP is 160/100mmHg or higher and ABPM and HBPM average is over 150/95mmHg

Question 3

What is severe hypertension?

Answer 3

Clinic BP is over 180mmHg systolic or 90mmHg diastolic

Question 4

When should ambulatory monitoring be offered?

Answer 4

Above 140/90mmHg

Question 5

When should treatment be considered immediately without the need for ABPM or HBPM?

Answer 5

If severe hypertension

Question 6

What are the symptoms of hypertension?

Answer 6

Asymptomatic, headache or possibly headache

Question 7

What would the symptoms be for someone with phaeochromocytoma?

Answer 7

Sweating, headache, palpitations and anxiety

Question 8

What would the symptoms be for someone with hyperaldosteronism?

Answer 8

muscle weakness or tetany

Question 9

What are the risk factors for hypertension?

Answer 9

CVS risks such as TIA, stoke, diabetes, previous renal disease, smoking, cholesterol, excess NSAIDs, angina, palpitations, syncope, valvular heart disease, family history, drugs

Question 10

On physical assessment what would you look for in someone with hypertension?

Answer 10

Cushing syndrome signs, enlarged kidneys (PCK disease) renal bruit, radio-femoral delay (coarctation)

Question 11

What investigations would you do for someone with hypertension?

Answer 11

test for protein in the urine- albumin:creatinine ratio and haematuria
blood sample- glucose, electrolytes, creatinine, estimated GFR, serum total cholesterol and HDL cholesterol, Fundi for hypertensive retinopathy, 12 lead ECG, ECHO if suggestion of LVH, valve disease or LVSD or diastolic dysfunction

Question 12

What would the K and Na in the blood be like if there is hyperaldosteronism?

Answer 12

low K and high Na

Question 13

When should treatment be offered in stage 1 hypertension?

Answer 13

if over 80, target organ damage, cardiovascular disease, renal impairment, diabetes and 10 year risk above 20 precent

Question 14

When should treatment be offered in stage 2 hypertension?

Answer 14

always

Question 15

What is the target blood pressure in low-moderate risk patients?

Answer 15

less than 140mmHg

Question 16

What is the target blood pressure in patients with previous stroke/tia, IHD or CKD?

Answer 16

less than 130/80

Question 17

In elderly hypertensives with a systolic blood pressure over 160 what is the target blood pressure?

Answer 17

140-150mmHg

Question 18

What is the target diastolic blood pressure in all patients?

Answer 18

less than 90 except diabetes which is less than 85

Question 19

What is the non-pharmalogical management of hypertension?

Answer 19

weight reduction if BMI is above 25, reduce salt intake, alcohol and smoking, increase exercise

Question 20

What is the pharmacological management for hypertension?

Answer 20

ACE inhibitor if under 55, CCB if over 55 or black, both as next level, add a thiazide diuretic next and then another diuretic as well as an alpha or beta blocker

Question 21

What is hypertensive crisis?

Answer 21

Increase in blood pressure which is sustained over the next few hours, which leads to irreversible end-organ damage

Question 22

What are some examples of end-organ damage?

Answer 22

Encephalopathy, LV failure, aortic dissection, unstable angina, renal failure

Question 23

How may the patient present with a hypertensive emergency?

Answer 23

emergency- High BP, encephalopathy, pulmonary oedema, AKI, MI or urgency (high BP with out critical illness)

Question 24

What is the aim of treatment in a hypertensive emergency?

Answer 24

to reduce diastolic BP to 110mmHg in 3-12 hours in emergency or within 24 hours in urgency

Question 25

What is the treatment for hypertensive emergency?

Answer 25

Sodium nitroprusside
Labetalol
GTN
Esmolol 
all by IV

Question 26

What is hypertensive urgency?

Answer 26

severe blood pressure elevation that will cause damage within days, diastolic is usually above 130mmHg and there will be retinal changes

Question 27

What drugs can be used to treat hypertensive urgency?

Answer 27

Usually use Nifedipine and Amlodipine, can also use Diltiazem, lisinopril, ACEi and CCB,

Question 28

What is Phaeochromocytoma?

Answer 28

Triad of episodic headache, sweating and tachycardia with sustained hypertension

Question 29

How is pheochromocytoma diagnosed?

Answer 29

measure urinary and plasma metanephrines and catecholamines by 24 hour urine collection, CT or MRI scan of abdomen and pelvis to detect adrenal tumours, MIBG scan can also detect tumours

Question 30

What is the treatment for pheochromocytoma?

Answer 30

resection and then alpha and beta blockers e.g. phenooxybenzamine

Question 31

What would be present on investigations of cushings?

Answer 31

hyperglycaemia, 24 hour urine cortisol excretion may be elevated, low dose dexamethasone suppression test, adrenal CT