Hypertension

Question 1

Define (essential) hypertension

Answer 1

Essential hypertension is defined as blood pressure (BP) ≥140/90 mmHg, with no secondary cause identified

Question 2

What are causes of secondary hypertension?

Answer 2

Cushing’s, Conn’s, phaeochromocytoma, acromegaly, renal disease, drugs e.g. NSAIDs, cocaine, coarctation of aorta

Question 3

What extra investigations should you do for hypertension?

Answer 3

Fasting glucose
Lipid panel
Cholesterol (to quantify cardiovascular risk)

Investigations to rule out secondary causes if suspected e.g.

• renin and aldosterone (Conn’s)
• U+Es

Investigations to look for end-organ damage e.g. ECG, echo, fundoscopy

Question 4

What is the management of hypertension?

Answer 4

Lifestyle modifications

For those < 55, use an ACEi or ARB

For those > 55 and/or black, use a calcium channel blocker

Combined therapy:

add in the other one or add a thiazide

All 3.

Then try spironolactone, BB (but don’t use BB with calcium blocker)

Question 5

What are complications of hypertension?

Answer 5

• CAD
  
  • Stroke
  • LVH
  • Congestive heart failure
  • Retinopathy
  • CKD
  • Aortic dissection
  • Peripheral artery disease
  • Malignant hypertension

Question 6

What are risk factors for hypertension?

Answer 6

> 65 years, moderate/high alcohol intake, lack of exercise, family history of hypertension or coronary artery disease, obesity, metabolic syndrome, diabetes mellitus, hyperuricaemia, black ancestry, and obstructive sleep apnoea.

Question 7

How should BP be measured to diagnose hypertension?

Answer 7

> 2 readings on > 2 visits

24 hour ambulatory BP monitoring or home BP monitoring