Hypertension

Question 1

How would you classify HTN?

Answer 1

Primary - essential HTN

Secondary - consider for specialist Ix in patients < 40 yrs old

Question 2

What are the different causes of secondary HTN?

Answer 2

Question 3

What are the different stages of HTN?

Answer 3

Stage 1:

Home > 135/85

Clinic > 140/90

Stage 2:

Home > 150/95

Clinic > 160/100

Stage 3:

Home/Clinic > 180/120

Question 4

Investigations to rule out end-organ damage in primary HTN?

Answer 4

FBCs, U&Es, LFTs

Lipid profile, HbA1c –> assess for risk of CV events in future (Heart/Brain)

–> QRisk score to calculate risk of cardiovascular events

Bedside test: ECG

eGFR, albumin:creatinine ratio, dipstick for haematuria and proteinuria –> Assess for kidney damage

Fundoscopy –> for Hypertensive Retinopathy

Question 5

Management of HTN?

Answer 5

ARB preferred for those of Afro-Carribean descent unless diabetic then give ACE-i

Can give beta-blocker i.e Atenolol in place of alpha-blocker in Step 4 Tx

Question 6

What are the blood pressure targets for HTN?

Answer 6

Question 7

What are the blood pressure targets for patients with HTN?

Answer 7

Question 8

What are the different steps of HTN Mx? 1st-line, 2nd-line, 3rd-line?

Answer 8

Question 9

What are the common drug classes used in Hypertension and what are some common side effects?

Answer 9

Beta-blockers i.e atenolol –> postural hypotension, bradycardia, erectile dysfunction, cold peripheries

Alpha-blockers i.e doxazosin –> postural hypotension

Aldosterone antagonists i.e spironolactone –> hyperkalaemia, gynaecomastia

Question 10

Give one ECG finding in hypertension and what is the significance?

Answer 10

Left ventricular hypertrophy - worse prognosis for patient/end-organ damage

Question 11

3 investigations to perform to investigate end-organ damage in HTN

Answer 11

Echocardiogram

Fundoscopy

Albumin:creatinine ratio