Hypertension

Question 1

Step 1 hypertension management

Answer 1

< 55 and non-black, + type 2 diabetes
- ACEi / ARB

Examples

• Ramipril
• Losartan
• Enalapril

> 55, black

• CCB
• Thiazide if CCB not tolerated

Examples
- Amlodipine

Question 2

Step 2 hypertension management

Answer 2

Combination therapy

• ACEi/ ARB + CCB/ thiazide (<55)
• CCB + thiazide/ARB/ACEi (>55 or black)

Question 3

Step 3 hypertension management

Answer 3

ARB/ACEi + CCB + thiazide

Question 4

Step 4 hypertension treatment

Answer 4

At this step- diagnosed as resistant hypertension

• Low-dose spironolactone (if K <4.5)
• Beta or Alpha-blocker (if K >4.5)

Question 5

Severe hypertension definition

Answer 5

BP > 180/120 mmHg

Question 6

Initial management of severe hypertension

Answer 6

If no signs/symptoms
- Assess for end organ damage

Question 7

Assessing for end organ damage in hypertension

Answer 7

Cardiac
- ECG: left ventricular hypertrophy, MI

Eyes
- Ophthalmoscope –> papilloedema/ retinal haemorrhage

Kidneys

• U+Es, eGFR
• Urine albumin: creatinine

Question 8

Life-threatening signs in severe hypertension

Answer 8

Requires referral for specialist assessment

• Eyes= retinal haemorrhage/ papilloedema
• Chest pain
• New confusion
• AKI
• HF signs (peripheral oedema, chest pain, exercise intolerance)