Hypertension

Question 1

What is an indication of end organ damage accompanying hypertension?

Answer 1

Left Ventricular Hypertrophy
Creatinine Raised
Albuminuria / microalbuminuria
Retinopathy

Question 2

Which are the 4 vasular diseases which increase CV risk by 20% over 10 years?

Answer 2

Ischaemic Heart Disease
Cerbro-Vascular Diseased
Peripheral Vascular Disease
Diabetes

Question 3

what type of blood pressure monitoring is used on people with suspected white coat effect?

Answer 3

abilatory BP monitoring or home BP monitoring

Question 4

Common causes of secondary hypertension

Answer 4

Renal disease
Obstructive Sleep Apnoea
Aldosteronism
Reno-vascular Disease

Question 5

Uncommon causes of secondary hypertension

Answer 5

Cushing’s
Pheochromocytoma (aldosterone secreting hormone)
Hyperparathyroidism
Aortic coarctation
Intracranial tumor
Fibromuscular Dysplasia (more common in young women)

Question 6

What are the current limits for hypertension

Answer 6

140/90 mmHg in people < 80 in clinic
< 135/85 mmHg in people < 80 ABPM
150/90 mmHg in people 80 & over in clinic
145/85 mmHg in people 80 & over ABPM

Question 7

What advice should be given to help to reduce the risk of hypertension?

Answer 7

Alcohol reduction should be recommended in heavy drinkers
Weight loss 1mmHg for every kg
Reduce salt intake - if you don’t eat salt, BP doesn’t increase with age
More aerobic exercise

Question 8

Blood Pressure reducing drugs

Answer 8

Thiazide diuretics
ACE Inhibitors / ARBs
Calcium Channel Blockers
Beta Blockers
Spironolactone, Alpha blockers, centrally acting, older drugs

Question 9

What hypertension drug should you give for angina?

Answer 9

Beta blockers or Ca blockers

Question 10

What hypertension drug should you give for CCF?

Answer 10

Diuretics, ACEi & B blockers

Question 11

What hypertension drug should you give for diabetic nephropathy?

Answer 11

ACEi/ARBs

Question 12

What hypertension drug should you give for prostatism?

Answer 12

alpha blockers - don’t give to women as causes incontinence

Question 13

What hypertension drug should you give to the elderly?

Answer 13

thiazides

Question 14

If hypertension treatment isn’t effective should you add another low dose drug or up the dose?

Answer 14

add another drug

Question 15

Why do 2 drugs have fewer side effects?

Answer 15

because the tachycardia or side effects are counteracted by the other drug also having a pressure lowering effect

Question 16

What are the BP targets for managed hypertension?

Answer 16

140/90 mmHg and if tolerated 130/80 mmHg or lower in most patients
> 65 & Diabetes, 140-130mmHg but NOT < 120mmHg
Very old 140-130mmHg but NOT < 130mmHg

Question 17

What is resistant hypertension?

Answer 17

BP that’s still really high even on 3 drugs

Question 18

What are the causes of resistant hypertension?

Answer 18

Non-concordance
‘White Coat’ Effect
Pseudo-Hypertension
Lifestyle Factors
Drug Interactions
Secondary Hypertension
True Resistance

Question 19

How to manage resistant hypertension?

Answer 19

Make sure they take their tablets

really limit salt

Question 20

What drug should you give once people have resistant hypertension?

Answer 20

Spironolactone - start low and go slow and monitor renal function