Hypertension

Question 1

What is hypertension?

Answer 1

Term to describe increased BP

Question 2

What is essential HT also known as?

Answer 2

Primary hypertension

Question 3

What is primary hypertension?

Answer 3

Hypertension that has developed on it’s own, no secondary cause

Question 4

Secondary Causes of hypertension?

Answer 4

R- renal disease (most common)
O- Obesity
P- Pregnancy induced HT/Pre-eclampsia
E- Endocrine (primarily consider hyperaldosteronism eg Conn’s syndrome)

Question 5

How do you investigate to see if someone has Conn’s syndrome?

Answer 5

Renin: aldosterone ratio blood test

Question 6

Complications of hypertension?

Answer 6

Ischaemic Heart Disease
Cerebrovascular Accident (stroke/haemorrhage)
Hypertensive retinopathy
Hypertensive nephropathy 
Heart Failure

Question 7

How can a diagnosis be made?

Answer 7

From 24h ambulatory BP or home readings

Question 8

White coat syndrome?

Answer 8

Increased BP when around Drs and hospitals

Question 9

Clinical and home readings expected of stage 1 hypertension?

Answer 9

>140/90= clinical
>135/85= Home

Question 10

Clinical and home readings expected of stage 2 hypertension?

Answer 10

> 160/100

>150/95

Question 11

Medications for HT?

Answer 11

A- ACE inhibitors (ramipril 1.25-10mg once daily)
B- Beta blockers (bisoprolol 5-20mg once daily)
C- Calcium channel blockers (amlodopine 5-10mg once daily)
D- Thiazide like Diuretic (indapamide 2.5mg once daily)

Question 12

Example of an ACEi?

Answer 12

Ramipril

Question 13

Example of a beta blocker?

Answer 13

Bisoprolol

Question 14

Example of a calcium channel blocker?

Answer 14

Amlodopine

Question 15

Example of a thiazide like diuretic?

Answer 15

Indapamide

Question 16

What to use if ACEi aren’t tolerated?

Answer 16

ARB

Candesartan

Question 17

Reasons that an ACEi wouldn’t be tolerated?

Answer 17

Dry cough

Black descent

Question 18

Who does he medical guidelines differ slightly for in treating HT?

Answer 18

People under age 55

Black people

Question 19

Medical guidelines for HT?

Answer 19

Step 1: Non-black, under 55 y/o= ACEi. Over 55 y/o or black patients use CCB.

Step 2: Non-black= A+ C. Black use ARB instead of A

Step 3: A + C+ D

Step 4: A + C + D +D

Question 20

What is spironolactone?

Answer 20

K+ sparing diuretic

Question 21

What does spironolactone do?

Answer 21

Blocks action of aldosterone in kidneys resulting in Na+ excretion & K+ reabsorption

Question 22

What is spironolactone helpful for?

Answer 22

When thiazide diuretics cause hypokalaemia

Question 23

Risk of spironolactone?

Answer 23

Hyperkalaemia aswell as ACEis

Question 24

Always monitor —– when patients are on diuretics or ACEis?

Answer 24

U&Es

Question 25

Target for diastolic pressure when treating HT?

Answer 25

Always under 90mmHG

Question 26

Target systolic pressure for under 80’s?

Answer 26

<140/<90

Question 27

Target systolic pressure for over 80’s?

Answer 27

<150/<90

Question 28

BP for diabetics with HT should be around?

Answer 28

<130/<80

Question 29

Which drug reduces complications in diabetic HT’s?

Answer 29

ACEis (particularly renal)

Question 30

When are ACEis not first line treatment for diabetic HT?

Answer 30

• Women with child bearing potential - instead use CCB

- Black patients- use ARBs + CCB