Hypertension

Question 1

Describe some complications of HTN

Answer 1

Brain- stroke, haemorrhage
Heart- LVH, CHD, CHF, MI
Kidney- renal failure, proteinuria 
Eye- retinopathy
Peripheral vascular Disease

Question 2

Define Stage 1 HTN

Answer 2

Clinical BP= 140/90

ABPM- 135/85

Question 3

Define Stage 2

Answer 3

Clinical= 160/100
ABPM= 150/95

Question 4

Define Severe HTN

Answer 4

Either systolic over 180 or diastolic over 110

Question 5

What percentage of HTN is primary (idiopathic)?

Answer 5

90%

Question 6

Risk Factors?

Answer 6

Male 
Smoker
Age 55+ 
Post menopausal Women
Obesity
Previous MI/ Stroke
Diabetes
Hyperlipidaemia
General Low fitness
LV hypertrophy

Question 7

How does birth weight influence HTN?

Answer 7

Low birth weight increases risk

Question 8

What is the influence of genes?

Answer 8

May be more common in families- predisposed risk

Question 9

List the causes of Secondary HTN

Answer 9

Renal Disease- sodium and water retention
Drug Induced- NSAIDs, OTC, Steroids
Pregnancy- pre-eclampsia
Endocrine- Conn's, Cushings
Vascular- coarctation of aorta
Sleep Apnoea

Question 10

Name two ways of monitoring Blood Pressure

Answer 10

ABPM- ambulatory BP monitoring

HBPM- Home BP monitoring

Question 11

How would you assess end organ damage?

Answer 11

ECG & ECHO- heart failure, LVH
Renal Ultrasound- Kidney failure, eGFR
Blood tests- proteinuria, LFT

Question 12

What treatable causes would you screen for?

Answer 12

Renal Artery Stenosis
Fibromuscular Dysplasia
Cushings
Conn's Syndrome
Sleep Apnoea

Question 13

Why treat HTN?

Answer 13

Reduce risk of Stroke by 40-50%

Reduce incidence of MI- 15-30%

Question 14

How to treat?

Answer 14

Stepped Approach

Question 15

Which drugs?

Answer 15

YOUNG U55= ACE Inhibitor/ ARB
Over 55= CCB
Afro Carribean= CCB
Women of child bearing age= CCB

Question 16

Why use ARB not ACEI?

Answer 16

ACE Inhibitors cause a persistent annoying cough. ARBs are less likely to cause this.
Losartan, Valsartan

Question 17

Other drugs?

Answer 17

Thiazide Type Diuretic

• Indapamide
• Clortalidone.

Question 18

Resistant HTN?

Answer 18

Spironolactone 25m o.d. if Potassium is below 4.5mmol/l

Question 19

What does ACE stand for and name two types

Answer 19

Angiotensin Converting Enzyme
Ramapril
Perindopril

Question 20

When can you not use ACE Inhibitors?

Answer 20

Renal Failure, Renal Artery Stenosis, Hyperkalaemia

Question 21

CCB?

Name the two different actions and give examples

Answer 21

Calcium Channel Blocker
Vasodilator- Amlodipine
Rate Limiting- Diltiazem, Verapamil