HYPERTENSION

Question 1

What is hypertension?

Answer 1

A blood pressure over 140/90mmHg

Question 2

What is Primary and Secondary Hypertension? Which is most common?

Answer 2

Primary - develops over time without identifiable causes

Secondary - occurs quickly and becomes more severe and is due to an underlying condition

Question 3

What are the 3 stages of hypertension?

Answer 3

Stage 1: 135/85 to 149/94

Stage 2: 150/95 to 180/119

Stage 3: >180/120

Question 4

What is severe (stage 3) hypertension?

Answer 4

Hypertensive Urgency or Hypertensive Emergency

Question 5

What is Hypertensive Urgency?

Answer 5

Stage 3 hypertension without target organ damage

Question 6

What are the symptoms of hypertension urgency? How do you manage it?

Answer 6

Severe headache, bradypnoea, noise bleed (epistaxis), severe anxiety

Oral medication, observe patient in Outpatient

Question 7

What is the symptoms with Hypertension Emergency? How do you manage it?

Answer 7

Chest pain, bradypnoea, numbness, weakness, vision change, difficulty speaking

Manage with IV Medication (because it’s faster) and monitor in ICU

Question 8

What is Hypertensive Emergency?

Answer 8

Stage 3 Hypertension with target organ damage

Question 9

What is the name of the serious condition that can occur during Hypertensive Emergency?

Answer 9

Encephalopathy

Cerebral arterial slide ability to regulate blood flow to capillaries > cerebral oedema > increase cerebral pressure > brain dysfunction

Question 10

What are the common renal causes of secondary hypertension?

Answer 10

Diabetic Nephropathy - damage to kidney filtering system > high creatinine and abnormal urinalysis

Polycystic Kidney Disease - cysts form in kidney causing enlargement

Glomerulonephritis - inflammation of glomerular > sodium retention > fluid overload

Question 11

What are common endocrine causes of Secondary Hypertension?

Answer 11

Cushing’s Syndrome - hypercortisolemia > hyperactive RAAS and suppression of vasodilator system

Pheochromocytoma - rare rumour of the adrenal gland > increase Epinephrine and Norepinephrine > increase peripheral and coronary vasoconstriction (check meta nephrons in urine or serum catecholamines)

Primary Aldosteronism - loss of potassium and retention of sodium > increase blood volume and pressure

Hyperthyrodism - T3 increase C. Output by increasing left ventricular contractility > Systolic Hypertension

Hypothyroidism - decreased release of endothelial-derived relaxing factor > promotes contraction > increase peripheral vascular resistance

Question 12

How does Coarctation of the Aorta lead to secondary hypertension?

Answer 12

Aorta is narrowed which cause the heart to pump more harder

You will see a high BP in the arms and a delayed femoral pulse, low or unobtainable BP in the legs

Question 13

What is Cushing’s Syndrome and how does it lead to hypertension?

Answer 13

Condition caused by hypercortisolemia

Too much glucocorticoids causes activation of RAAS and suppression of vasodilatory system

Question 14

What is Pheochromocytoma and How does it cause hypertension?

Answer 14

Rare tumour of the adrenal gland tissue causing increased epinephrine and norepinephrine

This leads to increased vasoconstriction, heart rate and blood pressure

Question 15

What are the top symptoms of hypertension?

Answer 15

flushing

Dizziness

Blood in the Urine

Headaches

Nosebleed

Question 16

What are the physical examination of the Hypertension?

Answer 16

Dyspnoea

Decreased visual acuity and Papilloedema

BP > 140/90 mmHg

Question 17

What are the top risk factors of Hypertension?

Answer 17

> 65yo

Alcohol

Tobacco

High salt diets

Lack of exercise

family History of Hypertension or CAD

Diabetes

Black ancestry

Question 18

When is a ABPM offered?

Answer 18

BP between 140/90 - 180/120 mmHg

Used to confirm diagnosis

2x reading per hour throughout a normal working day

Question 19

What is a HBPM?

Answer 19

It is an alternative to ABPM to diagnosis hypertension

2 consecutive reading 1min apart 2x per day for 4-7days

Question 20

What are the tests for assessing Target Organ Damage?

Answer 20

Lipid Panel

U&E, eGFR

Urinalysis

HbA1c (anaemia or polycythaemia - renal failure)

ECG (left ventricular hypertrophy or old infarction - talk QRS complex, v1-3 ST elevation, v4-6 inverted T waves)

QRISK3 SCORE (risk of CVD - at 10% begin treatment to prevent CVD)

Question 21

What is the first line management of Hypertension?

Answer 21

ACEi or ARB if under 55yo or diabetic (Lisopril or Candesartan)

CCB if over 55yo or Black ancestry (amlopdine)

Question 22

What is the second line treatment of Hypertension?

Answer 22

First line + CCB/THIAZIDE DIURETIC if under 55yo or diabetic ( Diuretic = chortalidone)

First Line + ACEi/ARB or DIURETIC of over 55yo or black ancestry

Question 23

What is the final step treatment if hypertension is resistant?

Answer 23

low-dose spironolactone (blood potassium <4.5mmol/l)

alpha or beta blocker (blood potassium >4.5mmol/l)

Question 24

What are the complications of Hypertension?

Answer 24

Hypertensive Retinopathy - thickening of retinal artery walls = swelling

Hypertensive Cerebrovascular Disease - encephalopathy and haemorrhage

Left Ventricular Hypertrophy

Ischaemic Heart Disease

Hypertensive nephropathy - nephrosclerosis