Hypertension

Question 1

Hypertension ABPM diagnostic threshold

Answer 1

135/85

Question 2

Who to treat HT

Answer 2

All with BP≥160/100 (or ABPM 150/95)

≥135/85 ABPM + CV risk>20%/10yrs or end organ damage

Question 3

Malignant HT pathological findings

Answer 3

Vascular damage so fibrinoid necrosis in wall of blood vessels

Question 4

Malignant HT prognosis

Answer 4

Untreated 90% die in 1yr

Treated 70% survive to 5 yrs

Question 5

Malignant HT signs + symptoms

Answer 5

Severe HT
Bilateral retinal haemorrhages
Headache ± visual disturbance

Question 6

Types of HT

Answer 6

1˚ - 95%

2˚ to renal/ endo/ other causes

Question 7

Grades hypertensive retinopathy

Answer 7

1 - silver/copper wiring arteries
2 - AV nipping (arteries cross veins)
3 - Flame haemorrhages + cotton-wool spots
4 - Papilloedema

Question 8

Treatment goal HT

Answer 8

<140/90
<130/80 in diabetes
150/90 if >80yrs

Reduce BP slowly

Question 9

Lifestyle management HT

Answer 9

Stop smoking
Control other CV RFs
Low-fat diet
Reduce alcohol + salt intake
Increase exercise
Lose weight if obese

Question 10

HT pharmacotherapy

Answer 10

Ca channel antagonist or thiazide if ≥55yrs or black
ACE-i/ARB if <55

ACE-i + Ca blocker/thiazide diuretic 2nd line
All 3 3rd line

Consider adding spironolactone 25-50mg/24h or beta-blocker 4th

Question 11

HT Ca blocker drug + dose

Answer 11

Amlodipine 10mg/24h PO

Question 12

HT thiazide drug + dose

Answer 12

Chlortalidone 25-50mg/24h PO in the morning

Question 13

HT beta-blocker drug + dose

Answer 13

Atenolol 25mg/24h PO

Question 14

HT ARB drug + dose

Answer 14

Candesarten 8-32mg/d

Question 15

Malignant HT management

Answer 15

Controlled BP reduction, don’t use sublingual nifedipine as too quick so stroke risk
Oral therapy unless encephalopathy/CCF

For encephalopathy:
Reduce BP to 110 diastolic over 4h
IV labetalol 50mg IV over 1min every 5 mins or
Na nitroprusside 0.5mcg/kg/min IVI titrated up to 8mcg/kg/min