management of hypetension 💊

Question 1

hypertension?

Answer 1

sbp: >140
dbp: > 90
twice on 2 separate occasions

Question 2

resistant hpt?

Answer 2

bp not controlled on 3 or more drugs

Question 3

secondary causes of hpt?

Answer 3

thyroid, renal, vascular, OSA, cushings or steroid intake
screen for all these!!

Question 4

target organ damage

Answer 4

heart- LVH, CHD, HF
brain- TIA, stroke
peripheral vasculature- absence of pulses in extremities +/- intermittent claudication, carotid bruit, AAA
kidney- CKD
retina- hemorrhages, exudates, papilloedema

Question 5

investigations to order for hpt?

Answer 5

fbc, rft, rbg, lipid profile, ufeme, ecg

Question 6

Non-Pharmacological Management

Answer 6

1. Weight Reduction
   
   • evidence showed a reduction of 1kg in weight relates to 1 mmHg reduction in SBP
2. Sodium Intake:
   
   • WHO recommends a reduction of sodium <2 g/day or salt <5 g/day (about one teaspoon of salt) in adults
3. Alcohol Consumption:
   
   • limit alcohol consumption to < 2 drinks per day.
4. Regular Physical Activity
   
   • Cumulative moderate intensity aerobic exercise of at least 150 minutes per week is advised
5. Healthy Diet
6. Smoking cessation
7. Relaxation Therapy
8. Increase Dietary potassium intake
   
   • This can be achieved by eating fruits, vegetables, nuts and legumes.

Question 7

pharmacological mx

Answer 7

acei and arb are generally safe to give
dont give b blocker in asthma pt

Question 8

antihypertensives in pregnancy

Answer 8

labetalol is first line

Question 9

if one antihpt not enough, what to do?

Answer 9

increase dose, change meds, add meds

Question 10

what is severe hypertension

Answer 10

sbp: 180
dbp: 110

Question 11

what is the difference between hypertensive urgency and emergency

Answer 11

urgency no acute end organ damage
emergency is new or progressive such as AHF, ACS, ARF, intracranial hemorrhage, ischemic stroke

Question 12

what antihypertensives to avoid during acute heart failure?

Answer 12

b blockers and ccb

Question 13

how to investigate pheochromocytoma

Answer 13

urine metanephrines