Hypertension common specialist areas

Question 1

hypertension during pregnancy

Answer 1

second most common cause of maternal and foetal death. complicated up to 10% of pregnancies. chronic hypertension complicates 1% to 4%. during normal pregnancy the BP falls but sometimes it can rise and patients develop hypertensio. can progress to preeclampsia

Question 2

treatment of hypertension during pregnancy

Answer 2

most are teratogenic or fetotoxic so be careful. nifedipine MR, methyl dopa, labetalol, atenolol are safe

Question 3

preeclampsia and treatment

Answer 3

greater CVD risk later in life. depends on trimester of pregnancy ( nifedipine MR, methyl dopa, labetalol) plus labetalol intravenously or hydralazine or esmolol

Question 4

gestational and hypertension treatment

Answer 4

greater CVD risk later in life. depends on trimester of pregnancy ( nifedipine MR, methyl dopa, labetalol)

Question 5

acute severe hypertension

Answer 5

hypertensive emergency or hypertensive urgency

Question 6

hypertensive emergency

Answer 6

severely elevated BP with evidence of acute target organ damage. require admission for BP reduction. malignant hypertension. target BP- lower systolic BP by 10-20% in first hour and then two 160/100mmHg over next 6 hours. start oral medication as soon as target BP is reached

Question 7

hypertensive urgency

Answer 7

severely elevated BP with NO evidence of acute target organ damage. do not need admission snd can be started on dual oral therapy and assessed after 24 hours. accelerated hypertension

Question 8

orthostatic hypotension

Answer 8

strongly associated with hypertension: prevalence for rates of OH and hypertension range from 13.4 to 32.1% depending on the age and comorbid medical conditions, blood pressure drop while shifting to standing. blood pressure decrease of 20mmHg systolic and or diastolic pressure of 10mmHg within three mins of standing. loss of nocturnal dip

Question 9

risks associated with OH

Answer 9

syncope along with danger of falling, increase in cardiovascular risk, link to heart failure and atrial fibrillation and possibly dementia, increased prevalence of stroke and coronary disease

Question 10

causes of orthostatic hypotension

Answer 10

age, diabetes, antihypertensive drugs, autoimmune systemic diseases, neurological syndromes eg multiple system atrophy, Parkinson’s, pure autonomic failure

Question 11

treatment of OH non pharmacological

Answer 11

teach manoeuvres either mobilising volume from lower parts of body or stimulating pressure receptors leading to vasoconstriction eg rising on heels repeatedly or isometric handgrips, tilting bed at night, glass of cold water before bed,

Question 12

treatment of OH pharmacological

Answer 12

lack of evidence of efficacy. many patients are still hypertensive despite the Oh episodes so cannot be treated easily. reduce dose of the responsible drug if the Oh is drug induced, fludrocortisone or Midodrine perhaps, but neither good as can worsen hypertension