Hypertension - General info

Question 1

Step 1 - <55

Answer 1

ACEi or ARB
If CI/not tolerated = B-blocker

Question 2

Step 1 - >55 OR afro-caribbean)

Answer 2

CCB
If high risk of heart failure or CCB not tolerated/CI = TLD

Question 3

Step 2 - <55

Answer 3

Add CCB
If high risk of heart failure or CCB not tolerated/CI = TLD

Question 4

Step 2 - >55 OR afro-caribbean)

Answer 4

Add ACEi/ARB
ARB preferred in afro-caribbean patients.

Question 5

Step 3

Answer 5

ACEi/ARB + CCB + TLD

Question 6

Step 4 (resistant hypertension)

Answer 6

Diuretics
- Low dose spironolactone OR
- High dose TLD if K+ >4.5
If other diuretics CI/Ineffective add Alpha or Beta-blocker.

Question 7

Normal BP

Answer 7

120/80 mmHG

Question 8

Stage 1 hypertension

Answer 8

140/90 mmHG or ABPM 135/85 mmHG

Offer lifestyle advice.
Only treat if under 80 with:
- Target organ damage (left ventricular hypertrophy, CKD, retinopathy).
- CVD or 10 year CVD risk >20%
- Renal disease
- Diabetes

Question 9

Stage 2 hypertension

Answer 9

160/100 mmHG or ABPM 150/95 mmHG

Treat ALL

Question 10

Stage 3 hypertension

Answer 10

Hypertensive crises
>180 systolic
>110 diastolic

Question 11

Hypertensive emergency

Answer 11

Hypertensive emergency = acute target organ damage
IV antihypertensives
Aim to reduce BP slowly, otherwise there is reduced organ perfusion.
Reduced organ perfusion = blindness, MI, cerebral infarction, severe renal impairment.

Question 12

Hypertensive urgency

Answer 12

Hypertensive urgency = without target organ damage.
Oral antihypertensives.
Aim to reduce BP slowly over 24-48 hours.

Question 13

<80 years

Answer 13

<140/90 mmHG
130/80 in atherosclerotic CVD or diabetes with kidney, eye or cerebrovascular disease.

Question 14

80+ years

Answer 14

<150/90

Question 15

Renal disease

Answer 15

<140/90 mmHG
130/80 if:
- CKD
- Diabetes
- Proteinuria >1g in 24 hours (consider ACEi/ARB if proteinuria present)

Question 16

Diabetic

Answer 16

<140/90
<130/80 if complications; eye, kidney or cerebrovascular disease.

Question 17

Pregnant

Answer 17

<150/100 chronic hypertension
<140/90 chronic hypertension (in patients with complications e.g. target organ damage or given birth)

Question 18

Management of hypertension in pregnancy

Answer 18

1st choice = labetalol

Methyldopa (stop 2 days after birth)
MR nifedipine (unlicensed)