Hypertension

Question 1

what reading is diagnostic of hypertension

Answer 1

clinic reading persistently above 140/90

24 hour ambulatory average reading above 135/85

Question 2

if BP is above 140/90 in clinic, what further investigation is needed?

Answer 2

24 hour ambulatory blood pressure monitoring to confirm diagnosis

Question 3

stage 1 HTN criteria

Answer 3

clinic BP > 140/90 and ABPM > 135/85

Question 4

stage 2 HTN criteria

Answer 4

clinic BP > 160/100 and ABPM > 150/95

Question 5

stage 3 HTN criteria

Answer 5

clinic BP > 180/110

Question 6

complications of HTN

Answer 6

ischaemic heart disease
cerebrovascular incident 
hypertensive retinopathy
hypertensive nephropathy 
heart failure

Question 7

what investigations should all patients with new HTN diagnosis receive

Answer 7

urine albumin:creatinine ratio for proteinuria
urine dipstick for microscopic haematuria
bloods for HbA1c, lipids, renal function
fundoscopy for retinopathy
ECG for cardiac abnormalities

Question 8

step 1 tx patients < 55 years old or with T2DM

Answer 8

ACE inhibitor e.g. ramipril or ARB e.g. losartan if ACE not tolerated

Question 9

step 1 tx patients > 55 years old or afro-carribean ethnicity

Answer 9

Calcium channel blocker e.g amlodipine

Question 10

step 2 tx

Answer 10

if taking ACEI – add calcium channel blocker / thiazide diuretic
if taking calcium channel blocker – add ACE/ARB

Question 11

step 3 tx

Answer 11

ACEI + Calcium channel blocker + thiazide diuretic

Question 12

step 4 tx if potassium < 4.5

Answer 12

add spironolactone

Question 13

step 4 tx if potassium > 4.5

Answer 13

add an alpha (doxazosin) or beta blocker (atenolol)

Question 14

common side effects of ACEI

Answer 14

cough
hyperkalaemia
angioedema

Question 15

common side effects of calcium channel blockers

Answer 15

ankle swelling
flushing
headache

Question 16

common side effects of thiazide diuretics

Answer 16

hypokalaemia

hyponatraemia

Question 17

common side effects of spironolactone

Answer 17

gynaecomastia

hyperkalaemia

Question 18

causes of secondary HTN

Answer 18

Renal disease
Obesity
Pregnancy induced / pre-eclampsia
Endocrine e.g Conns syndrome (HTN + low K)

Question 19

test for conns syndrome

Answer 19

renin: aldosterone ratio

- high aldosterone levels, low renin