Hypertension Pathology

Question 1

Name some cardiovascular risk factors

Answer 1

• Weight/ BMI
• Smoking
• Exercise
• HBP
• Alcohol abuse
• Family history

Question 2

What is an ideal BMI?

Answer 2

18.5 Underweight
18.5-24.9 Healthy weight
25–29.9 Overweight
30-34.9 Obese (class 1 obesity)
35-39.9 Severe obesity (class 2 obesity)
40-50 Morbid obesity (class 3 obesity)
50-60 Super obesity
>60 Super-morbid obesity

Question 3

What are the grades of hypertensive retinopathy?

Answer 3

1: Silver wiring
2: + AV nipping
3: + Flame Haemorrhages
4: + Papilloedem + cotton wool spots + Hard exudates

Question 4

Other than retinopathy, what signs might you see in a hypertensive patient?

Answer 4

LVH
Heaves
S4 (stiff ventricle)
Bruits

Question 5

What are some causes of hypertension?

Answer 5

1. Essential (idiopathic) (95
5 in over 55's, lower in under)
2. Conns Syndrome
3. Phaeochromocytoma
4. Cushing's 
5. Acromegaly
6. Co-arctation of the aorta
7. Renal Artery stenosis

Question 6

How do you investigate HTN?

Answer 6

1. Bloods
   i. FBC (polycythaemia)
   ii. U/E (Low K- renal)
   iii. Fasting glucose (diabetes)
   iv. Lipids
2. ECG (LVH)
3. Urinalysis (renal disease)

Question 7

What are the features of a phaeochromocytoma?

Answer 7

Nervousness

Sweat pouring down face

Racing heartbeat

Episodic severe hypertension

Question 8

How do you treat a phaechromocytoma?

Answer 8

Alpha block
Beta block
Fluid resuscitation
Surgery

Question 9

What are the definitions of the grades of hypertension?

Answer 9

Normal = 120/80
High = 139/89
Gd 1 HTN = 140-159/ 90-99
Gd 2 = 160-179/ 100-109
Gd 3 = >180 / > 110

Question 10

How do you treat HTN?

Answer 10

A (U55) or C/ D (55+/ black)

A plus C or A plus D

A plus C plus D

Then add a further diuretic OR alpha blocker OR beta blocker

Question 11

What is the best combination to use?

Answer 11

Lifestyle change

Statins and aspirin for lipid events

T2DM assessment

Thiazide diuretic plus beta blocker/ amlodipine

Question 12

Why are PCSK9 inh not as useful?

Answer 12

Evidence is poor and slightly fudged

Question 13

When do we use PCSK9 inh?

Answer 13

Statin intolerant
Uncontrolled lipids in FH
High net value patients

Question 14

Give an example of a PCSK9 inh

Answer 14

Evolocumab