Specialist areas in hypertension practise

Question 1

What is the 2nd most common cause of maternal and foetal death ?

Answer 1

Hypertension during pregnancy

Question 2

What % of pregnancies does hypertesnion complicate ?

Answer 2

10%

Question 3

What is the treatment of hypertension during pregnancy ?

Answer 3

Chronic hypertension, pre-pregnancy planning is essential:

- pre pregnancy clinic 
- not ACE or ARB or stop and convert to safer antihypertensive
- nifedipine MR, methyldopa, labetalol, atenolol

Question 4

What is the treatment of gestational hypertension ?

Answer 4

Depends on the trimester of pregnancy

Add nifedipine MR, methyldopa, labetalol

Question 5

What is preeclampsia ?

Answer 5

persistent high blood pressure that develops during pregnancy or the postpartum period and is often associated with high levels of protein in the urine OR the new development of decreased blood platelets

Question 6

What is the risk of having gestational hypertesnion or preeclampsia ?

Answer 6

Greater risk of CVD later in life with 65% chnace of events occuring before age 40

Question 7

What does preeclampsia increase the risk of ?

Answer 7

Stroke HR 1.9 
Cardiac atherosclerotic event HR 1.67
Heart failure HR 1.82
Peripheral events 1.82
Atrial fibrillation HR 2.12
Chronic hypertension HR 4.47

Question 8

What is a hypertensive emergency ?

Answer 8

Severely elevated BP

BP >180/120mmHg with evidence of acute target organ damage

Question 9

Should patients with hypertensive emergency be admitted to hospital ?

Answer 9

Yes, require admission for BP reduction

Question 10

What is a hypertensive urgency ?

Answer 10

Severely elevated BP with NO

evidence of acute target organ damage

Question 11

Does hypertensive urgency require hospital admission ?

Answer 11

No, can be started on dual oral therapy and assessed after 24hrs

Question 12

What is the hypertensive emergency target BP- in everyone exept acute ischaemic stroke and aortic dissection ?

Answer 12

Aim to lower systolic BP by 10-20% within the first hour and then to 160/100mmHg over the subsequent 6 hours
More aggressive and rapid lowering of BP is associated with an increase in morbidity and mortality

Question 13

When should oral medication be started for a hypertensive emergency ?

Answer 13

Start oral medication as soon as target BP is achieved and ween of IV medications over the next 12-24 hours

Question 14

What is the take home message in treatment of hypertensive emergencies ?

Answer 14

Do not lower BP in hypertensive emergencies rapidly and never start an ACI or ARB in pateints with a hypertensive emergency

Question 15

What are the only indications for rapid BP lowering ?

Answer 15

Ischaemic stroke: for pateints in whom BP>/= 185/110mmHg, who are eligible for or who have received thrombolysis within previous 24hrs or BP>/= 220/120mmHg and not eligible for thrombolysis
Aortic dissection- systolic BP should be rapidly lowered to a target of between 100 to 120mmHg systolic

Question 16

What is orthostatic hypotesnion ?

Answer 16

low blood pressure that happens when you stand up from sitting or lying down

Question 17

What is constitutional hypotension ?

Answer 17

Permenant low BP

Question 18

What type of hypotension is common in elderly ?

Answer 18

Orthostatic hypotension

Question 19

What type of hypotension is common in the young ?

Answer 19

Constitutional hypotension

Question 20

What is OH defined as ?

Answer 20

A BP decreases of 20mmHg systolic and or diastolic pressure of 10mmHg within three minutes of standing

Question 21

What are the risks associated with OH ?

Answer 21

Syncope along with the danger of falling and the “immediate” risk of fractures. Detrimental impact on quality of life and loss of confidence may be severe Syncope along with the danger of falling and the “immediate” risk of fractures. Detrimental impact on quality of life and loss of confidence may be severe

Question 22

What are the causes of OH ?

Answer 22

Ageing
Diabetes
Antihypertensive drugs
Auto-immune systemic diseases
Neurological syndromes: pure autonomic failure,     multiple system atrophy, Parkinson’s disease

Question 23

What is the treatment of OH ?

Answer 23

Teach manoeuvres either mobilising volume from the lower parts of the body or stimulating pressure receptors leading to vasoconstriction
At night, tilting the bed so that the patient is in a “head-up” position may be effective.
Because some OH patients are frequently hypertensive during the day, tilting the bed may prevent a further blood pressure rise during the night.
A similar beneficial effect could be exerted by drinking a glass of ice-cold water prior to going to be

Question 24

What is the pharmacological treatment of OH ?

Answer 24

Many drugs have been proposed for the prevention and control of low blood pressure episodes in conditions such as OH
But robust evidence of efficacy is lacking.
These agents may increase the 24-hour BP profile, which could be useful in patients with constitutional hypotension, but not in OH patients, especially when, besides the OH episodes, they are hypertensive