Hypertension

Question 1

What is hypertension?

Answer 1

High blood pressure

>140/90

Question 2

What is stage 1 hypertension?

Answer 2

> 140/90

Question 3

What is stage 2 hypertension?

Answer 3

> 160/100

Question 4

What is severe hypertension?

Answer 4

> 180 systolic

>110 diastolic

Question 5

What is hypertension in renal or diabetic patients?

Answer 5

> 130/80

Question 6

What is prehypertension?

Answer 6

Elevated BP below stage 1 with no signs of end organ damage

Question 7

How is prehypertension managed?

Answer 7

Regular exercise
Weight loss
Reduce stress
Smoking cessation 
Reduce sodium

Question 8

What is primary hypertension?

Answer 8

Idiopathic - no cause

Question 9

What is secondary hypertension?

Answer 9

Hypertension with an underlying cause

Question 10

What can cause secondary hypertension?

Answer 10

Renal artery stenosis
Phaeochromocytoma
Cushing’s syndrome
Conn’s syndrome

Question 11

What is malignant hypertension?

Answer 11

Severe hypertension (>200 systolic or >130 diastolic)
+
Bilateral retinal haemorrhages and exudates

Question 12

What are the symptoms of malignant hypertension?

Answer 12

Headaches

Visual disturbances

Question 13

What investigations are done for patients with hypertension?

Answer 13

Urine dip
- proteinuria = renal damage

Fundoscopy

• flame haemorrhages
• papilloedema
• retinopathy

Bloods

• FBC
• U+Es

Ultrasound - kidney + adrenals

Question 14

What are complications of hypertension?

Answer 14

Renal damage
Retinopathy 
IHD 
MI 
Stroke

Question 15

How is hypertensive retinopathy staged?

Answer 15

Stage 1 = torturous arteries with thick walls
Stage 2 = AV nipping
Stage 3 = flame haemorrhages and cotton wool spots
Stage 4 = papilloedema

Question 16

What are flame haemorrhages

Answer 16

Haemorrhages from retinal capillaries

Question 17

What are cotton wool spots?

Answer 17

Damage to nerve firbres appearing as fluffy white patches on retina

Question 18

What is papilloedema?

Answer 18

Optic disc swelling

Question 19

What is management in under 55s?

Answer 19

Step 1 = ACEi
Step 2 = ACEi + CCB
Step 3 = ACEi + CCB + D
Step 4 = ACEi + CCB + D + spironolactone

Question 20

What is management in over 55s or afro-Caribbean?

Answer 20

Step 1 = CCB
Step 2 = ACEi + CCB
Step 3 = ACEi + CCB + D
Step 4 = ACEi + CCB + D + spironolactone

Question 21

What is a side effect of ACEis?

Answer 21

Dry cough

Question 22

What is a side effect of CCB?

Answer 22

Flushing
Oedema
Palpitations

Question 23

What is a side effect of a thiazide like diuretic?

Answer 23

Hypokalaemia

Question 24

Where does a thiazide like diuretic act?

Answer 24

DCT