Hypertension

Question 1

describe the definition of stage 1 hypertension

Answer 1

clinical BP ranging from 140/90 to 159/99 mmHg

AND home/ambulatory BP ranging from 135/85 to 149/94 mmHg

Question 2

describe the definition of stage 2 hypertension

Answer 2

clinical BP of 160/100 or higher, but less than 180/120

AND home/ambulatory BP of 150/95 or higher

Question 3

describe the definition of stage 3 or severe hypertension

Answer 3

clinical sytolic BP >180 OR clinical diastolic BP >120

Question 4

what is the main cause of hypertension

Answer 4

primary- no identifiable cause(95%)

Question 5

give some secondary causes of hypertension

Answer 5

drugs, aortic stenosis, fluid overload

Question 6

what investigations other than BP are used in hypertension

Answer 6

urine, bloods, ECG, fundoscopy

look for organ damage and assess cardio risk

Question 7

what score system is used to assess 10 year cardiovascular disease risk

Answer 7

QRISK

Question 8

what lifestyle changes are suggested for hypertension patients

Answer 8

exercise more, stop smoking and limit salt, alcohol + caffeine

Question 9

in what circumstances are statins and aspirin indicated for hypertension

Answer 9

statins = for prevention if CV risk in 10 years >20%
aspirin = if significant risk of bleeding

Question 10

what is the 1st step of hypertension drug treatment in those with type 2 diabetes or that are <55y/o and not of black african or african-carribean origin

Answer 10

ACE(e.g. lisinopril) or ARB(e.g. losartan)

Question 11

what is the 1st step of hypertension drug treatment in those >55y/o and/or of black african or african Caribbean origin
(without type 2 diabetes)

Answer 11

CCB(e.g. amlodipine)

Question 12

what is the 2nd step of hypertension drug treatment in those with type 2 diabetes or that are <55y/o and not of black african or african-Caribbean origin

Answer 12

ACE(e.g. lisinopril) or ARB(e.g. losartan)
+
CCB(e.g. amlodipine) or thiazide-like diuretic(e.g. bendroflumethazide)

Question 13

what is the 2nd step of hypertension drug treatment in those >55y/o and/or of black african or african Caribbean origin
(without type 2 diabetes)

Answer 13

CCB(e.g. amlodipine)
+
ACE(e.g. lisinopril) or ARB(e.g. losartan) or thiazide-like diuretic(e.g. bendroflumethazide)

Question 14

what is step 3 in hypertension drug treatment for all patients

Answer 14

ACE(e.g. lisinopril) or ARB(e.g. losartan)
+
CCB(e.g. amlodipine)
+
thiazide-like diuretic(e.g. bendroflumethazide)

Question 15

describe step 4 of hypertension drug treatment

Answer 15

seek expert advice or
if K levels <4.5mmol/L spironolactone can be added
if K levels >4.5 mmol/L alpha or beta-blockers can be added