Hypertension

Question 1

What are the causes of secondary hypertension?

Answer 1

ROPE

R- Renal disease (most common)
O- Obesity
P- Pregnancy induced hypertension (pre-eclampsia)
E- Endocrine, primarily hyperaldosteronism (conn’s syndrome)

Question 2

What are the complications of hypertension?

Answer 2

Ischaemic heart disease

Cerebrovascular accident e.g stroke

Hypertensive retinopathy

Hypertensive nephropathy

Heart failure

Question 3

What are the clinical and home readings for all 3 stages of hypertension?

Answer 3

Stage 1:

Clinic- over 140/90
Home- over 135/85

Stage 2:
Clinic- over 160/100
Home- over 150/95

Stage 3:
Clinic- over 180/20
Home- N/A

Question 4

What investigations should all patients with a new diagnosis of Hypertension have?

Answer 4

Urine albumin:creatinine ratio for proteinuria

Urine dipstick for microscopic harmaturia (kidney damage)

Bloods (HBA1c, renal function and lipids)

Fundus examination for hypertensive retinopathy

ECG for cardiac abnormalities

Question 5

What medications are used to treat hypertension?

Answer 5

ABCD

A- ACE inhibitor or ARB
B- Beta blocker
C- Calcium channel blocker
D- thiazide like Diuretic

Note: these are not in order of how you prescribe them, merely an acronym of remembering

Question 6

What medications would you prescribe initially for hypertension accounting for age, ethnicity, diabetes and pregnancy

Answer 6

Step 1:

ACE inhibitor if non- black and under 55

If over 55 or black use Calcium channel blocker

If pregnant use a beta blocker

If diabetic use ACE inhibitor even if black

Question 7

What medications would you prescribe for hypertension if initial treatment was unsuccessful? accounting for age, ethnicity, diabetes

Answer 7

If under 55 and not black prescribe calcium channel blocker

If over 55 prescribe ACE inhibitor

If black prescribe ARB

If diabetic prescribe ramipril

Question 8

What medications would you prescribe for hypertension after second line treatment fails? accounting for age, ethnicity, diabetes

Answer 8

If under 55 and not black prescribe thiazide like diuretic

If over 55 or black prescribe thiazide like diuretic

If diabetic prescribe thiazide like diuretic

Question 9

What are the treatment targets for hypertension if the individual is below or above 80 years old?

Answer 9

Below 80:

Systolic under 140
Diastolic under 90

Over 80:

Systolic under 150
Diastolic under 90