Hypertension

Question 1

What is hypertension?

Answer 1

• Raised BP >= 140/90mmHg

* Or 24hr BP average reading of >= 135/85

Question 2

What is essential hypertension?

Answer 2

No single disease causing the rise in BP

Question 3

What is secondary hypertension?

Answer 3

Caused by something else

Question 4

What are the causes of secondary HTN?

Answer 4

Renal disease:
>Glomerulonephritis
>Chronic pyelonephritis
>Adult polycystic kidney disease

Endocrine:
>Cushings
>Congenital adrenal hyperplasia
>Acromegaly 
>Primary hyeraldosteronism
>Phaeochromocytoma

Other:
>NSAIDs
>Pregnancy
>Coartation of the aorta
>COCP
>Glucocorticoids

Question 5

What is the presentation of hypertension usually?

Answer 5

Asymptomatic

Question 6

When would hypertension cause symptoms? What would these be?

Answer 6

• > 200/120mmHg

Symptoms:

• Headaches
• Visual disturbance
• seizures

Question 7

What investigations should be done following a diagnosis of hypertension?

Answer 7

• U&Es
• HbA1c
• lipids
• ECG
• Urine dip

Question 8

What is the management of hypertension <55 or Type 2 diabetic?

Answer 8

Step 1 First line:
ACEi / ARB

Step 2:
Add in Ca2+ blocker of thiazide like diuretic

Step 3:
Use all

Step 4:
Consider alpha blocker/beta blocker if K+ 4.5
Consider Spironolactone is K+<4.5

Question 9

What is the management of hypertension >55 or afro-carribean? No type 2 diabetic

Answer 9

Step 1 First line:
Ca2+ channel blocker

Step 2:
Add in ACEi/ARB or thiazide like diuretic

Step 3:
Use all

Step 4:
Consider alpha blocker/beta blocker if K+ 4.5
Consider Spironolactone is K+<4.5

Question 10

What is required for a diagnosis of hypertension?

Answer 10

*Ambulatory BP
>2 reading per hour and use average of 14 measures

*Home BP monitor
>2 consecutive readings teen 1min apart 
>BP recorded twice daily 
>BP recording 4-7days
>Average value discard first day readings

Question 11

What is stage 1 hypertensions?

Answer 11

Clinic BP >= 140/90

Average home reading >135/80

Question 12

What is stage 2 hypertension?

Answer 12

Clinic BP >=160/100

Average home reading >=150/95

Question 13

What is severe hypertension?

Answer 13

Clinic BP systolic >=180 or diastolic >=120

Question 14

What is the management of severe hypertension?

Answer 14

*Admit for specialist assessment

Question 15

What are blood pressure targets for under 80 years?

Answer 15

140/90 in clinic or

135/85 at home

Question 16

What are blood pressure targets for over 80 years?

Answer 16

150/90 in clinic or

145/85 at home