Hypertension

Question 1

What qualifies as high BP?

Answer 1

140/90 in clinic

135/85 with ambulatory readings

Question 2

What are the secondary causes of HTN? (4)

Answer 2

R - renal disease
O - obesity
P - pregnancy / pre-eclampsia
E - endocrine (Conn’s syndrome)

Question 3

Complications of HTN (5)

Answer 3

Ischaemic heart disease
Cerebrovascular accident (i.e. stroke or haemorrhage)
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure

Question 4

Stages of HTN

Answer 4

I - >140/90 (135/85)

II - >160/100 (150/95)

III - >180/120

Question 5

What investigations does NICE recommend for someone with a new diagnosis of HTN? (4)

Answer 5

Urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to ASSESS KIDNEY DAMAGE
Bloods for HbA1c, renal function and lipids
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities

Question 6

Medication for HTN?

Answer 6

A – ACE inhibitor (ramipril 1.25mg up to 10mg once daily)
B – Beta blocker (e.g. bisoprolol 5mg up to 20mg once daily)
C – Calcium channel blocker (e.g. amlodipine 5mg up to 10mg once daily)
D – Thiazide-like diuretic (e.g. indapamide 2.5mg once daily)
ARB – Angiotensin II receptor blocker (e.g. candesartan 8mg to up 32mg once daily)

Question 7

Medical management of HTN

Answer 7

<55 or non-black use ACEi (A)
>55 or black use CCB (C)

Step 2 = both (ARB if black) (A+C)

Step 3 = both + thiazide diuretic (A+C+D)

Step 4 = if K+ <4.5 consider spironolactone
if >4.5 use doxazosin or beta blocker