Hypertension

Question 1

What is the target BP in >80s?

Answer 1

150/90

Question 2

What is stage 1 HT?

Answer 2

> 140/90 (>135/85 ABPM)

Question 3

What is stage 2 HT?

Answer 3

> 160/100 (ABPM >150/95)

Question 4

What is stage 3 HT?

Answer 4

> 180/110 (ABPM >diastolic 110)

Question 5

What is white coat HT?

Answer 5

high BP in clinical setting but normal at home

Question 6

What must be done to confirm HT?

Answer 6

if BP > 140/90 offer ABPM this must be done to confirm the diagnosis

Question 7

Where is HT in higher incidence undeveloped/developed countries?

Answer 7

developed

Question 8

Name the clinic signs and tests used to assess risk?

Answer 8

test for proteinuria
take bloods
fundoscopy
ECG
Age

Question 9

What tests are useful for detecting LVH + strain?

Answer 9

ECHO

MRI

Question 10

What treatment is offered after stage 1?

Answer 10

lifestyle advice

Question 11

What treatment is offered after stage 2?

Answer 11

HT treatment

Question 12

Combination/monotherapy is better in HT?

Answer 12

combination

Question 13

How is benign HT found ?

Answer 13

asymptomatic accidental finding on health checks

Question 14

Every 10mmHG of diastolic above 85 ____ risk of MI

Answer 14

doubles

Question 15

Every 8mmHg of diastolic pressure above 85 doubles risk of _____

Answer 15

stroke

Question 16

What does HT do to BV walls?

Answer 16

Causes blood vessel wall changes in small arteries and arterioles (also retina and kidneys)
Thickens Media (smooth muscle)

Question 17

What is HT arteriosclerosis?

Answer 17

plasma proteins forced into the vessel wall

Question 18

What is Malignant HT? Is it Life threatening?

Answer 18

Life threatening (diastolic >130-140)

Question 19

How does Malignant HT develop and what does it require?

Answer 19

develops from benign primary or secondary, requires urgent treatment

Question 20

What doe Malignant HT cause?

Answer 20

cerebral oedema
acute renal failure, acute HF
headache and cerebral haemorrhage
blood vessels show fibrinoid necrosis

Question 21

What is the risk with Pregnant women and HT?

Answer 21

Pre-Eclampsia = hypertension and proteinuria

. Increased maternal and foetal morbidity and mortality.

Question 22

What drugs are pregnant women given for HT?

Answer 22

beta blockers

Question 23

Explain the treatment plan for a HT patient under 55yrs of age?

Answer 23

1 ACE/ARB 
2 ACE/ARB + Ca2+ Channel Blocker
3 ACE/ARB + Ca2+ + thiazide
4 refer
lifestyle advice

Question 24

Explain treatment plan for HT over 55 years?

Answer 24

ca2+ channel blocker or thiazide diuretic

Question 25

Why may a patient over 55 be put on a thiazide drug instead of Ca2+?

Answer 25

Ca2+ causes ankle oedema

Thiazide reduces this and also if the patient has Heart FAILURE

Question 26

What is a side effect of Thiazide/

Answer 26

can cause gout

Question 27

Name the investigation to test for urine and what you are looking for in HT?

Answer 27

urinalysis

protein or blood

Question 28

What are you looking for in ECG for HT?

Answer 28

ventricular hypertrophy

Question 29

What is the test for the eye in HT and what are we looking for?

Answer 29

fundoscopy
papilloedema
haemorrhages and exudates

Question 30

Name some causes of secondary HT?

Answer 30

Cushing’s syndrome
Conn’s Syndrome
Phaeochromocytoma
Renal Disease

Question 31

What are the complications of HT?

Answer 31

Cerebrovascular disease
Retinopathy
Kidney disease

Question 32

How can too much salt lead to hypertension?

Answer 32

Increases release of aldosterone, which causes salt and fluid retention [part of RAAS]

Question 33

How can renal disease lead to hypertension?

Answer 33

Reduced renal flow causes excess renin release, ultimately leading to fluid overload

Question 34

Conn’s syndrome is an endocrine cause of hypertension - what happens?

Answer 34

Excess production of aldosterone, leading to fluid overload

Question 35

What blood vessel changes occur in hypertension?

Answer 35

Thickening of media (smooth muscle) layer

Arteriosclerosis (hardened arteries)