hypertension

Question 1

Hypertension - definition

Answer 1

elevated BP, 2 occasions, > 1 week apart

Question 2

Hypertension - when to treat with antihypertensive rx

Answer 2

Low CVD risk, BP ≥ 160/100
Mod CVD risk, BP ≥ 140/90
High CVD risk, BP >140/90, improved outcomes/fewer CVD events for SBP ≤120

Question 3

Hypertension, treatment target

Answer 3

<140/90

Question 4

Hypertension Rx management - how to titrate

Answer 4

1. commence 1st line antihypertensive Rx (ACE-I or ARB)
   Review response/BP at 6-12/52
2. if still high/>target, add a 2nd antihypertensive Rx (CCB)
   Review response/BP at 3/12
3. if still high/>target, incrementally increase dose of 1st Rx (up to max dose)
   Review response/BP every 6/52
4. if still high/>target at 6/12, incrementally increase dose of 2nd Rx (up to max dose)
   Review response/BP every 6/52
5. if still high/>target at 9/12, add 3rd antihypertensive Rx (thiazide diuretic)
   check adherence
   consider 2ndary causes of HTN
6. if still high/>target, at 12/12
   seek expert advice, from cardiology

Question 5

Hypertension Rx management - effective combinations

Answer 5

ACE-I/ARB + CCB
ACE-I/ARB + Thiazide
ACE-I/ARB + CCB + thiazide
ACE-I/ARB + b-blocker
Thiazide + CCB

Question 6

Hypertension - secondary causes

Answer 6

Thyroid dysfunction/hypothyroid
renal artery stenosis
OSA
CKD

Rare:
Cushings syndrome
Conn's
Pheochromocytoma
CAH - nonclassical

consider in child/teens:
renal parenchymal disease/PKD
coarctation of aorta

Question 7

Essential Hypertension - possible causes for elevated BP /poor BP control in adults

Answer 7

Rx noncompliance
White coat hypertension
weight gain
excessive/increased ETOH intake
excessive/increased dietary salt intake
OSA
CKD
renal artery stenosis