Hypertensjon - Amboss

Question 1

Hva er definisjonen av hypertensjon (HT) hos voksne?

Answer 1

There is no consensus regarding the definition of hypertension. The definitions are those most commonly used in the US.

Question 2

Hva er definisjonen av HT hos barn?

Answer 2

Equivalent to the 2017 ACC/AHA definition.

Question 3

Hva mener man med hhv.:
- Primær HT
- Sekundær HT
- Resistent HT

Answer 3

The antihypertensives should be maximally dosed, work via different mechanisms, and include a diuretic.

Question 4

Hvordan klassifiserer ulike organisasjoner
- Normalt blodtrykk (BT)
- Forhøyet BT
- Stadium 1 HT
- Stadium 2 HT

Answer 4

Norge bruker JNC sin definisjon!

ACC; American College of Cardiology. AHA; American Heart Association. ICH; International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. The JNC 8 guideline does not offer new definitions but endorses those stated in the 2003 JNC (The Joint National Committee) 7 guideline.

Question 5

Hvordan er prevalensen av HT?

Amerikansk data

Answer 5

The percentages below are given in ranges, as they include the prevalence according to both the 2017 ACC/AHA definition of hypertension and the less conservative JNC 8 definition. However, the prevalence of hypertension among school-aged children and adolescents is increasing (particularly in those who are obese). The reasons for this are not entirely understood. Psychosocial, environmental, and related behavioral factors are considered primarily responsible for the higher prevalence of hypertension in African American individuals. These include chronic race-related and occupational stress, lower socioeconomic status, and cultural dietary patterns.

Question 6

Hvordan er forskjellene mellom prevalensen mellom kvinner og menn når det gjelder HT?

Amerikansk data

Answer 6

At ≥ 75 years of age, prevalence is higher in women than men.

Question 7

Hvilken etiologi gir primær HT?

Answer 7

Question 8

Hvilke risikofaktorer øker sannsynligheten for primær HT?
Hvilke risikofaktorer er det mulig å gjøre noe med?

Answer 8

It is suspected that insulin resistance in hyperinsulinemia leads to renal sodium retention and proliferation of vascular muscle cells (increased vascular resistance). Both processes cause blood pressure to increase. Excessive salt intake increases serum sodium levels and reduces the ability of the kidneys to properly remove water from the body. Blood volume expansion results in higher blood pressure and strain on the renal arteries, which respond with vasoconstriction, causing a further increase in peripheral resistance and elevation of blood pressure.

Question 9

Når gir HT alvorlige symptomer?

Answer 9

Ved komplikasjoner pga. “end-organ damage”:
- The damage sustained by organ systems as a result of systemic pathological states, particularly those of the circulatory system (e.g., chronic hypertension, hypertensive crisis, shock), which impair the perfusion of the brain, heart, kidneys, and other organs (e.g., eyes in hypertensive crises).

Ved akutt økt BT, f.eks. ved en hypertensiv krise.

Sekundær HT manifesterer seg vanligvis ved symptomer pga. av den underliggende sykdommen.

Since hypertension is often asymptomatic, regular screening is necessary to prevent end-organ damage.

Question 10

Hva er ikke-spesifikke symptomer på HT?

Answer 10

The pain is typically at the back of the head. Caused by nocturnal hypertension.

Question 11

Hva er “White-coat HT”?

Answer 11

Question 12

Hvordan kan man vise at BT-måling er et resultat pga. “White-coat effekten”?

Answer 12

ABPM; Ambulatory blood pressure measurement. HBPM; Home blood pressure measurement. If blood pressure remains elevated on HBPM, consider repeating screening with ABPM before initiating treatment.

Question 13

Hvordan behandler man pas. med “White coat HT”?

Answer 13

Question 14

Hva er definisjonen på maskert HT?

Answer 14

Called “masked uncontrolled hypertension” in patients currently on antihypertensive medication.

Question 15

Hvordan screener man pas. med mistenkt maskert HT?

Answer 15

This recommendation is from the 2017 ACC/AHA hypertension guidelines. The US Preventive Services Task Force (USPSTF) does not currently recommend screening for masked hypertension.

Question 16

Hvordan behandler man pas. med mistenkt maskert HT?

Answer 16

Question 17

Hva er definisjonen på isolert systolisk HT (SHT)?

Answer 17

Forhøyet systolisk BT (SBT ≥ 140) med diastolisk BT (DBT) innenfor normalverdi (≤ 90 mm Hg).
- This is the most commonly used definition, however, some sources use other cutoffs, e.g., SBP ≥ 130 mm Hg or ≥ 160 mm Hg.

Question 18

Hvilken etiologi kan isolert SHT ha?

Answer 18

Question 19

Hva slags klinikk har en pas. med isolert SHT, og hva er det viktig at man utelukker?

Answer 19

Asses for secondary cause.

Question 20

Hvordan behandler man isolert SHT?

Answer 20

Question 21

Hvilke tegn tyder på sekundær HT?

Answer 21

Alvorlig HT

Uvanlig start av HT

Uprovosert eller betydelig hypokalemi

Question 22

Ved sekundær HT, hva mener man at HT er av alvorlig type?

Answer 22

E.g., a patient with stage 1 hypertension but severe chronic kidney disease (CKD).

Question 23

Hva mener man at den sekundære HT har en uvanlig start?

Answer 23

Question 24

Hvilken sekundær HT skyldes en sjelden, men livstruende årsak til HT og kan gi forskjellig BT på høyre og venstre side?

Answer 24

Question 25

Hva er de vanligste årsakene til sekundær HT hos voksne?

Answer 25

Young adults (especially women < 40 years of age) with suspected secondary hypertension should be assessed for renal artery stenosis caused by fibromuscular dysplasia.

Question 26

Hva er de vanligste årsakene til sekundær HT hos barn?

Answer 26

Coarctation of the aorta (innsnevring av aorta); A congenital heart defect that involves the narrowing of the aorta at the aortic isthmus. Frequently associated with other congenital heart defects (e.g., bicuspid aortic valve, VSD and/or PDA) and Turner syndrome.

Question 27

Hva står RECENT for når det kommer til sekundære årsaker til HT?

Answer 27

RECENT:

Renal (e.g., renal artery stenosis, glomerulonephritis).

Endocrine (e.g., Cushing syndrome, hyperthyroidism, Conn syndrome).

Coarctation of the aorta.

Estrogen (oral contraceptives).

Neurological (raised intracranial pressure, psychostimulants use).

Treatment (e.g., glucocorticoids, NSAIDs)

The causes of secondary hypertension.

Question 28

Hvilke typer renale sykdommer kan gi sekundær HT?

Answer 28

De fleste renale sykdommer kan potensielt trigge hypertensjon.

Question 29

Hva kan årsaken til renal arteriestenose skyldes, og når bør man utelukke at dette er årsaken til den sekundære HT?
Hvilke us. kan man diagnostisere dette med?

Answer 29

Hypertension due to renal artery stenosis is known as renovascular hypertension. The use of contrast for these imaging methods depends on the patient's level of renal dysfunction.

Question 30

Hvilke årsaker kan føre til renal parenkymal sykdom, og når er det indikasjon for å utelukke at dette er årsaken til den sekundære HT?
Hvilke us. kan man diagnostisere dette med?

Answer 30

Question 31

Hvilken annen nyresykdom kan gi sekundær HT?

Answer 31

Kronisk nyresvikt.

Question 32

Hva er Conn syndrom, når er det indikasjon for å utelukke dette som årsak til HT og hva er typisk funn?

Answer 32

Hypokalemia may be significant if diuretic-induced but is not present in the majority of patients. Plasma renin concentration may be measured instead of renin activity. It is not necessary to stop a patient's antihypertensive medications prior to testing for primary hyperaldosteronism.

Question 33

Når er det indikasjon for å utelukke feokromocytom som årsak til HT, og hva er typiske funn?

Answer 33

Metanephrine; A metabolite of catecholamines (e.g., epinephrine and norepinephrine). Diaforese; svetting.

Question 34

Hva er Cushing syndrom, når er det indikasjon for å utelukke dette som årsak til HT og hva er typiske funn?

Answer 34

Plethora; a very large amount of something.

Question 35

Når er det grunn til å utelukke hypertyreose som årsak til HT, og hva er typiske funn?

Answer 35

Question 36

Når er det indikasjon for å utelukke primær hyperparatyreoidisme som årsak til HT, og hva er typiske funn?

Answer 36

Can manifest with abdominal pain, polyuria and polydipsia (the medical definition of excessive thirst), kidney stones, and altered mental status (e.g., confusion).

Question 37

Når er det indikasjon for å utelukke kongenital adrenal hyperplasi som årsak til HT, og hva er typiske funn?

Answer 37

Virtilization; The appearance of male secondary sexual characteristics (e.g., voice deepening, hirsutism, male-pattern hair loss, increased muscle mass, clitoromegaly) in a female individual. Can develop in any condition that causes hyperandrogenism.

Question 38

Når er det indikasjon for å utelukke akromegali som årsak til HT, og hva er typiske funn?

Answer 38

Question 39

Når er det indikasjon for å utelukke insnevring av aorta som årsak til HT, og hvilke us. kan gjøres?

Answer 39

Question 40

Hva er patofysiologien til HT ved obstruktiv søvnapné syndrom?

Answer 40

↑ katekolaminer ved apnéperioder → sekundær hypertensjon

Question 41

Når er det indikasjon for å utelukke OSAS som årsak til HT, og hvilke us. kan brukes? Hva er en god startbehandling?

Answer 41

Secondary hypertension due OSA is often resistant to medication. It is physiologically normal for blood pressure to drop by at least 10% while asleep. Patients without this pattern are often referred to as “nondippers.”

Question 42

Når er det indikasjon for å utelukke substansrelatert HT, og hvordan kan man us. dette?

Answer 42

Question 43

Hva gjør man først hos en pas. med mistenkt HT?

Answer 43

Workup should be directed by the specific abnormalities. There is no clear recommendation regarding the order of the workup in these patients but it may be reasonable to begin by ruling out the most common causes for each age group.

Question 44

Ved hvilken indikasjon screener man pas. for HT, og hvilken metode er det mest vanlig å bruke?

Answer 44

These recommendations are consistent with the 2021 USPSTF (The U.S. Preventive Services Task Force) recommendation statement. Recommendations by the ACC/AHA and other societies vary slightly. Measuring blood pressure at different times of the day and following different activities allows for a more comprehensive assessment of hypertension.

Question 45

Hvordan får man en diagnostisk bekreftelse på HT?

Answer 45

Blood pressure measurements are typically higher when obtained in the office than out of the office. Confirm the correct cuff size and train the individual on how to use the device. Ask them to record the average of two measurements taken a minute apart, before their morning medications.

Question 46

Hos pas. med nylig diagnostisert HT, hva bør man starte konsultasjonen med?

Medisinsk

Answer 46

Det første møte bør fokusere på å evaluere tegn på sekundære HT og målorganskade, og vurdere atherosklerose og kardiovaskulær risiko.

Question 47

Hvilke kliniske us. bør man ha med ved det første møte til en pas. med nydiagnostisert HT?

Answer 47

Including auscultation of carotid arteries and palpation of peripheral pulses

Question 48

Hvilke blodprøver er akt. hos en nydiagnostisert pas. med HT?

Answer 48

To establish a baseline before initiating antihypertensive medications that may alter electrolyte levels. To screen for hyperthyroidism, a treatable cause of hypertension. To detect microalbuminuria and/or hematuria. According to the 2017 ACC/AHA guidelines, the urinary albumin-to-creatinine ratio is optional, but in practice, it is frequently obtained. To check for early electrical changes associated with hypertensive heart disease (e.g., left ventricular hypertrophy) or concomitant heart disease (e.g., coronary artery disease, arrhythmias).

Question 49

Hvilke tilleggsus. er akt. hos en nydiagnostisert pas. med HT?

Answer 49

Currently not routinely recommended in the 2017 ACC/AHA guideline, however, it is recommended by the ISH and European Society of Cardiology as part of the initial workup. Hypertension may be related to the development of nonalcoholic fatty liver disease or nonalcoholic steatohepatitis. Levels may be increased by thiazides, so it can be helpful to establish a baseline level. Consider obtaining an echocardiogram for further evaluation of murmurs and for left ventricular hypertrophy in patients who have chronic uncontrolled hypertension, evidence of secondary hypertension, or symptoms of heart failure.

Question 50

Hvordan går man frem med behandling ved HT?

Answer 50

Recommendations regarding indications for treatment and target blood pressure differ between clinical practice guidelines. The following recommendations are consistent with those in the 2017 ACC/AHA guidelines unless specified otherwise; The more conservative 2017 ACC/AHA guidelines were based in part on data from the landmark 2015 SPRINT trial, which demonstrated cardiovascular benefit when treating high-risk individuals to a SBP of < 120 mm Hg, but was criticized for having potentially limited generalizability. Guidelines by the JNC 8, ISH, and European Society of Cardiology have more liberal treatment recommendations. The 2020 ISH guideline recommends an optimal target blood pressure of < 130/80 mm Hg for patients < 65 years of age, and a target of < 140/90 mm Hg for patients ≥ 65 years of age if tolerated. The 2014 JNC 8 guideline recommends a general treatment threshold and goal of < 140/90 mm Hg. This is strongly recommended for patients with known CVD or 10-year ASCVD risk ≥ 10%.

Question 51

Når er det indikasjon for at pas. med HT bare prøver livsstilsmodifikasjoner som behandling?

Answer 51

Nonpharmacological measures can also improve the efficacy of medications.

Question 52

Hva er den beste ikke-farmakologiske behandlingen ved HT?

Answer 52

Question 53

Hvilket kosthold bør pas. med HT tilstrebe å ha?

Answer 53

DASH; Dietary Approaches to Stop Hypertension. This may not be appropriate for patients with advanced CKD. However, any reduction in intake is beneficial. The 2021 KDIGO guideline suggests a threshold of < 2000 mg/day. Processed foods are the most significant source of sodium in the typical Western diet. Patients with CKD stages G3 to G5 should not be instructed to increase dietary potassium but should instead adjust intake to maintain normal potassium levels. Smoking cessation should be advised in all patients to reduce ASCVD risk.

Question 54

Hvilken type trening bør pas. med HT gjøre?

Answer 54

Evidence for the effect of aerobic exercise on blood pressure is more robust than for other forms of exercise. More is preferable and the 2021 KDIGO guidelines advise at least 150 minutes per week for patients with CKD. Patients should aim to walk briskly for 30–60 minutes, 5–7 days per week. Patients should aim to do 6 exercises, with 3 sets of each exercise, and 10 repetitions per set. Patients should aim to do 4 repetitions of a 2-minute hand grip.

Question 55

Når er det indikasjon for å starte med antihypertensiva ved HT?

Answer 55

The thresholds for pharmacological treatment are controversial and vary depending on age. These recommendations are based on the 2017 ACC/AHA guidelines.

Question 56

Hvilken initial medisinering bør man starte med ved HT?

Answer 56

This is the recommendation per the 2017 ACC/AHA guidelines. The 2018 European Society of Cardiology and 2020 ISH guidelines emphasize single-pill combination medication as a first-line treatment for almost all patients except frail older patients and those with grade 1 hypertension who are also at low cardiovascular risk. Comorbidities can be treated or adversely affected by antihypertensive treatment. For example, migraine and hyperthyroidism may benefit from beta blockers, which would not usually be a first-line choice. E.g., patients who drive vehicles all day may prefer not to start with a diuretic. Previous guidelines have recommended using only diuretics or CCBs to treat hypertension in Black patients without CKD. These recommendations have been criticized for multiple reasons, including making the incorrect assumption that all Black individuals are “salt-sensitive” with low renin levels and therefore particularly responsive to diuretics, and for denying Black patients the potential benefits of renin-angiotensin-aldosterone system inhibitors. Although not explicitly recommended by current US guidelines, experts have advised that a combination medication is a reasonable strategy for Black patients. The 2020 ISH guideline recommends the combination of a CCB and either a thiazide-type diuretic or an ARB.

Question 57

Ved hvilke indikasjoner bruker man ACEi og ARB som førstelinje anterhypertensiva?

Answer 57

Do not prescribe an ACEI and ARB together or in combination with a direct renin inhibitor. This increases the risk of hyperkalemia and renal dysfunction and does not provide additional benefit.

Question 58

Ved hvilke indikasjoner bruker man thiaziddiuretika og dihydropyridine kalsium kanal blokkere som førstelinjebehandling ved HT?
Hvilken kalsiumblokker bruker man i mindre grad?

Answer 58

Chlorthalidone is longer acting than hydrochlorothiazide and is the preferred choice according to the 2017 ACC/AHA guidelines.

Question 59

Ved hvilke tilfeller bruker man beta-blokkere som førstelinjebehandling ved HT?

Regnes som 2.linjebehandling.

Answer 59

Bisoprolol, metoprolol succinate, or carvedilol are preferred. Do not abruptly discontinue beta blockers or alpha-2 agonists. They must be slowly tapered to avoid triggering rebound hypertension.

Question 60

Når er det indisert med slyngediuretika ved HT?

2.linjebehandling

Answer 60

Question 61

Hvilke kaliumsparende diuretika kan man bruke ved HT, og når er dette indisert?

2.linjebehandling

Answer 61

Not very effective antihypertensives. Twice-daily dosing is often required for effective blood pressure control. Patients can be initiated on a lower starting dose of 10 mg and increased after 4 weeks to 20 mg.

Question 62

Hvilken type direkte renin inhibitorer kan man bruke ved 2.linjebehandling av HT?

Answer 62

Very long-acting.

Question 63

Ved hvilke indikasjoner bruker man alfa-1 blokkere mot HT?

Answer 63

Question 64

Hvilke typer alfa-2 blokkere kan man bruke som 2.linjebehandling ved HT?

Answer 64

May also be given in a transdermal form.

Question 65

Ved hvilke indikasjoner bruker man direkte ateriolære vasodilatatorer?

2.linjebehandling

Answer 65

Should be administered with a loop diuretic.

Question 66

Fyll inn figuren

Answer 66

Renin-angiotensin-aldosterone system: Flowchart summarizing the biochemical and physiological effects of the renin-angiotensin-aldosterone system.

Question 67

Hvordan virker medikamenter inn på RAAS?

Answer 67

Renin-angiotensin-aldosterone system: Flowchart summarizing the biochemical and physiological effects of the renin-angiotensin-aldosterone system and current pharmacological inhibitors (overlay).

Question 68

Pas. med HT og komorbiditet med slag eller TIA, hvordan bør denne HT-behandlingen legges opp?

Answer 68

Question 69

Hos pas. med stabil iskemisk hjertesykdom, hvordan bør HT-behandlingen legges opp?

Answer 69

Question 70

Hvordan bør HT-behandlingen av pas. med kronisk nyresvikt legges opp?

Answer 70

This recommendation is in accordance with the 2021 KDIGO CKD guidelines. The 2017 ACC/AHA hypertension guidelines make a weaker recommendation to consider an ACEI or ARB for patients with ≥ stage 3 CKD, or stage 1 or 2 CKD with overt proteinuria. This recommendation is in accordance with the 2021 KDIGO CKD guidelines. The 2017 ACC/AHA guidelines recommend a target blood pressure < 130/80 mm Hg

Question 71

Hvordan bør HT behandlingen være hos pas. med diabetes?

Answer 71

This recommendation is in accordance with the 2021 KDIGO CKD guidelines and the 2021 American Diabetes Association diabetes guidelines. The recommendation is weaker (“consider” ACEIs or ARBs) for patients with albuminuria in the 2017 ACC/AHA hypertension guidelines. The 2017 American Diabetes Association diabetes guidelines make a more liberal recommendation of < 140/90 mm Hg, with possible lower targets for patients with higher CV risk. Beta blockers can mask symptoms of hypoglycemia in patients with diabetes mellitus.

Question 72

Hvordan bør HT behandlingen være hos pas. med hjertesvikt?

Answer 72

Data to guide the treatment of hypertension in these patients is limited. Do not use nondihydropyridine CCBs in patients with HFrEF because of their myocardial depressant effects!

Question 73

Hvordan bør man behandle pas. med HT og astma?

Answer 73

Some evidence suggests increased asthma severity with ACEIs.

Question 74

Hvilken behandlin bør pas. med HT og osteoporose få?

Answer 74

Question 75

Hvordan bør behandlingen legges opp til pas. med urinsyregikt eller migrene ved HT?

Answer 75

Question 76

Hva er de generelle prinsippene ved oppfølgning av pas. med HT?

Answer 76

Goals include evaluating medication adherence, monitoring treatment and relevant laboratory studies, and adjusting medication. Earlier follow-up may be appropriate depending on the choice of drug, initial laboratory study results, and comorbidities. About 25% of patients will require further medication adjustment after the initial visit.

Question 77

Hvilke lab.prøver er akt. ved oppfølgningen av HT?

Answer 77

Due to increased risk of hyponatremia. Due to increased risk of hyperkalemia.

Question 78

Hvordan titrerer man seg opp til riktig HT behandling?

Answer 78

Vurder bivirkninger av medisinen, og juster dosene.

Juster medisineringen for å nå målet om optimalt BT.

Question 79

Hvordan vil man justere medisinene hvis pas. med HT får:
- Hyponatremi
- Hypokalemi
- Hyperkalemi
- Hoste

Answer 79

Question 80

Hvordan justerer man doseringen av medikamenter for å oppnå ultimat BTs-kontroll?

Answer 80

Patients should use HBPM to assist with medication titration. Nonadherence may occur in up to 80% of patients with hypertension who have been prescribed antihypertensives and may be related to a variety of factors, including intolerable adverse effects, financial burden, and confusion regarding dosing. According to JNC 8 and the 2017 ACC/AHA guidelines, use of any of these strategies is reasonable. The 2018 European Society of Cardiology/European Society of Hypertension (ESH) guidelines state that increasing the dose may not produce significant additional improvement in blood pressure and will increase the risk of adverse effects, while sequential monotherapy can result in a long period of uncontrolled hypertension. However, those approaches may be preferable to initial fixed-dose combination therapy in older frail patients, those with stage 1 hypertension and low CV risk, and those with a history of adverse reactions to medications. While this continues to be recommended by some experts, sequential monotherapy seems to be inferior to other strategies. > 1 drug is usually required to reach adequate blood pressure control.

Question 81

Hvordan vil man som allmennpraktiker angripe en pas. med resistent HT?

Answer 81

E.g., sympathomimetic drugs, corticosteroids, NSAIDs, oral contraceptives.

Question 82

Hva må man ha i bakhodet ved HT hos eldre?

Answer 82

Contributing factors include stiffening of the arteries over time and autonomic dysfunction. After age 60, SBP increases while DBP may start to decrease, resulting in a widened pulse pressure.

Question 83

Hvordan diagnostiserer man HT hos eldre?

Answer 83

Older adults are at increased risk of orthostatic hypotension, which may be exacerbated by antihypertensive treatment.

Question 84

Hvilke ikke-farmakologiske behandlinger bør man gi til eldre med HT?

Answer 84

Biofeedback training, meditation, and yoga can also help reduce blood pressure. E.g., NSAIDs, corticosteroids, decongestants.

Question 85

Hvilken type farmakologisk terapi gir man eldre med HT?

Answer 85

The ACC/AHA 2017 guideline recommends treating most adults ≥ 65 years of age if SBP ≥ 130 mm Hg. The 2020 ISH guideline recommends treating adults ≥ 50 years with BP ≥ 140/90 mm Hg. The AAFP/ACP 2017 guideline and the 2014 JNC 8 guidelines suggest treating if SBP ≥ 150 mm Hg for adults ≥ 60 years without significant comorbidities and ≥ 140 mm Hg for those with comorbidities (e.g., diabetes or history of stroke). In 2022, the AAFP released a guideline without the ACP suggesting treating adults of all ages with BP ≥ 140/90 mm Hg. The presence of ASCVD, for example, may warrant a lower BP goal, while cognitive impairment and increased fall risk may necessitate a higher BP goal. The patient's ability to follow directions and manage a complex medication regimen should also be considered. Older adults may require lower starting doses and slow titration. Some patients may require beta blockers due to comorbidities (e.g., atrial fibrillation)

Question 86

Hva må man ha i bakhodet ved HT hos barn?

Answer 86

Current treatment options may reverse end organ damage.

Question 87

Hvilke tilstander hos barn < 3 år predisponerer for HT?

Answer 87

Question 88

Hvilke tilstander predisponerer for HT hos barn ≥ 3 år?

Answer 88

Overvekt

Diabetes

Søvnrelaterte pusteproblemer:
- Children with obesity are less likely to have a reduction in BP after adenotonsillectomy

Question 89

Hva er normalt BT hos barn:
< 13 år
≥ 13 år

Answer 89

In children <13 years, thresholds for normal blood pressure and hypertension are based on BP percentiles that take into account age, height, and sex; in these age groups, normal blood pressure is significantly below 120/80 mm Hg. After 13 years of age, adult classifications of BP can be used since BP thresholds in adolescents align with those of adults. Classification of blood pressure in adolescents ≥ 13 years is the same as the classification of blood pressure in adults according to the 2017 ACC/AHA guidelines.

Question 90

Hva er forhøyet HT hos barn < 13 år og barn ≥ 13 år?

Answer 90

Question 91

Hva regnes som stadium 1/2 HT hos barn < 13 år og ≥ 13 år?

Answer 91

Question 92

Hva er akutt, alvorlig HT hos barn < 13 år og ≥ 13 år?

Answer 92

Question 93

Hvordan screener man for HT hos barn?

Answer 93

Question 94

Hvordan diagnostiserer man HT hos barn som er asymptomatiske?

Answer 94

The intervals between repeat visits depend on the severity of the HTN. After initial detection of elevated BP on screening, arrange a repeat measurement within 1 week for children with stage 2 HTN, within 1–2 weeks for children with stage 1 HTN, and in 6 months for children with elevated BP. If BP remains elevated on a second visit, blood pressure should be measured in both arms and one leg to exclude coarctation of the aorta, and children with persistent stage 2 HTN should be referred to a subspecialist. A third visit should be arranged in 3 months for children with stage 1 HTN and in 6 months for children with elevated BP. The significance of these markers has not been thoroughly evaluated in children. Electrocardiography is not recommended to screen for LVH because of low sensitivity in children.

Question 95

Når er det akt. å utelukke sekundære årsaker til HT hos barn?

Answer 95

E.g., abnormal urinalysis or renal function test. A complete evaluation for secondary hypertension is not necessary for hypertensive children > 6 years of age who are obese, have a family history of hypertension, and have no concerning history or physical examination findings.

Question 96

Hvordan går man frem med barn som har HT?

Answer 96

This includes children with symptomatic HTN or BP > 30 mm Hg over the 95th percentile. Hypertensive crises in children are almost always due to secondary hypertension. E.g., 30–60 minutes of moderate to vigorous activity 3–5 days per week combined with the DASH diet, stress reduction strategies. E.g., multidisciplinary team care for BMI ≥ 95th percentile, treatment of dyslipidemia in children, management of diabetes mellitus

Question 97

Når er det indikasjon for farmakoterapi hos barn med HT?

Answer 97

Question 98

Hvilke prinsipper gjelder ved utskrivning av antihypertensiva til barn?

Answer 98

Lifestyle modifications should be continued in all hypertensive children. Home blood pressure monitoring may be used to guide dosing adjustments.

Question 99

Hvilke antihypertensiva er akt. for barn med HT?

Answer 99

Research has shown that ACE inhibitors are less effective at lowering blood pressure in black individuals compared to other races and may require higher starting doses or a different starting agent.

Question 100

Hvordan følger man opp barn med HT, og hvilke preventive tiltak bør man sette i gang?

Answer 100

Question 101

Hvorfor blodtrykksbehandling så viktig?

Answer 101

Arterial hypertension is the most common risk factor for cardiovascular disease.

It leads to changes in the vascular endothelium, particularly of the small vessels, and can therefore affect any organ system.

Question 102

Hvilke komplikasjoner kan oppstå i det kardiovaskulære systemet pga. HT?

Answer 102

Hypertension is the most common risk factor for aortic dissection.

Question 103

Hvordan kan HT påvirke hjernen?

Answer 103

Usually hemorrhagic, but also ischemic stroke.

Question 104

Hva viser bildet?

Answer 104

Basal ganglia hemorrhage; CT head (without contrast; axial plane) of a patient with a history of chronic hypertension. Hyperdense hemorrhage in the left basal ganglia is surrounded by hypodense perifocal edema (red overlay). The location is typical for hemorrhage from the lenticulostriate arteries as a result of long-standing hypertension. 1: head of caudate nucleus; 2: putamen; 3 and green overlay: internal capsule; 4: thalamus Arrowheads: calcified pineal gland; white circles: calcified choroid plexus.

Question 105

Hva er hypertensiv nefrosklerose, og hva er patofysiologien?

Answer 105

Question 106

Hva er kliniske funn ved hypertensiv nefrosklerose?

Answer 106

Question 107

Hvordan diagnostiserer man hypertensiv nefrosklerose, og hva er behandlingen?

Answer 107

Question 108

På hvilken annen måte kan HT gi renale sykdommer?

Answer 108

Kan føre til kronisk nyresvikt.

Question 109

Hvilke endringer kan HT føre til i synssystemet?

Answer 109

Question 110

Hva ser man ved en fundoskopi av øynene ved hypertensiv retinopati?

Answer 110

In severe hypertension, the arteriole's thick arteriosclerotic wall compresses the vein where it crosses, which results in the vein forming an hourglass shape around the arteriole. Caused by segmental infarction of the choriocapillaris in individuals with malignant hypertension.

Question 111

Hva kan tilstedeværelsen av papilleødem være et tegn på?

Answer 111

The presence of papilledema in a hypertensive patient may indicate a hypertensive crisis and warrants urgent lowering of blood pressure.

Question 112

Hva er Keith-Wagner-Barker klassifikasjon?

Answer 112

Gunn sign; A tapering of a retinal venule at the point where a retinal arteriole crosses the retinal venule; creates an hourglass shape. Associated with advanced hypertensive retinopathy.

Question 113

Hva viser bildet?

Answer 113

Grade IV hypertensive retinopathy; Fundus photography of the right eye. There are cotton wool spots (blue overlay), narrow arterioles, and a retinal hemorrhage in close proximity to the papilla (hatched overlay). The papilla shows an unsharply demarcated margin nasally (blurry margin of the disc marked by dashed blue line, sharply demarcated margin marked by blue line), which is consistent with the diagnosis of papilledema. These findings are consistent with grade IV hypertensive retinopathy. M: Macula.

Question 114

Hva viser bildet?

Answer 114

Bilateral papilledema; Fundus photography of right (R) and left (L) optic disc of the same patient. The optic discs show severely blurred margins (dashed circle indicates supposed margin). The retinal veins are dilated and tortuous (examples marked by white lines). There are multiple peripapillary hemorrhages, which appear as flame-shaped hemorrhages (examples marked by blue overlay). Cotton wool spots are also present and appear as bright spots (examples marked by arrowheads). These features are characteristic of papilledema. If present bilaterally, possible causes include cranial hypertension or hypertensive emergency.