Hypertension

Question 1

Describe the staging of HTN.

Answer 1

Normal- less than 120/80
Pre- less than 140/90
1- 140/90+
2- 160/100+
3- 180/110+

Question 2

How is HTN sub-divided by cause?

Answer 2

• Primary/essential (idiopathic)
• Secondary (known cause)
• Malignant

Question 3

What are the causes of secondary HTN?

Answer 3

ROPE

• Renal disease e.g. renal artery stenosis
• Obesity
• Pregnancy (pre-eclampsia)
• Endocrine e.g. hyperaldosteronism

Question 4

How is HTN diagnosed?

Answer 4

• ABPM

or

• Home readings

Question 5

What BP readings may be used for HTN classification instead of the usual classification?

Answer 5

5 less for either sys or dias up to stage 1, 10 less for stage 2 sys

E.g. 135/85 for stage 1, 150/95 for stage 2

Question 6

What are the treatment targets for:

• age <80?
• age 80+?
• diabetics?

Answer 6

<80 140/90

80+ 150/90

Diabetics 130/80

Question 7

What lifestyle and diet advice should you give?

Answer 7

Diet
- Salt restrict, caffeine and alcohol restrict, balanced diet

Lifestyle

• 5x30minutes exercise
• Smoking cessation

Question 8

Outline the medical treatment for someone under 55/not black/T2DM (even if black).

Answer 8

1 A e.g. ramipril/losartan
2 A+C e.g. verapamil, amlodipine 
3 A+C+D e.g. indapamide (thiazide-like)
4 A+C+D+D e.g. spironolactone- only if K+ is less than 4.5
5 Referral

Question 9

Outline the medical treatment for someone over 55/black/not T2DM.

Answer 9

1 C e.g. amlodipine, verapamil
2 A+C e.g. ramipril, losartan if black
3 A+C+D e.g. indapamide (thiazide-like)
4 A+C+D+D e.g. spironolactone- only if K+ is less than 4.5
5 Referral

Question 10

What are the complications of HTN?

Answer 10

• Ischaemic heart disease e.g. ACS
• HF
• CVA
• Hypertensive retinopathy/nephropathy