Week 1 - A 35 year old woman with hypertension

Question 1

What condition(s) may be responsible for this patient’s presentation? What further history is required from her?

Answer 1

Question 2

Which drugs could be the cause of this patient’s hypertension?

Answer 2

Question 3

What is the definition of hypertension?
- In adults?
- In children?
- Primary?
- Secondary?
- Resistant?

Answer 3

Question 4

Classification of Hypertension?

Answer 4

Question 5

Epidemiology of HTN:
- Prevalence?
- Sex?

Answer 5

Question 6

Aetiology of Primary Hypertension?
- 3 Non-modificable Risk factors for primary HTN?
- 7 modificable Risk factors for primary HTN?

Answer 6

Question 7

Which clinical signs are suggestive of secondary HTN vs. Primary/Essential HTN?

Answer 7

Question 8

What is the RECENT acronym for remembering the causes of secondary hypertension?
- What are the most common causes of secondary HTN in adults?
- What are the most common causes of secondary HTN in children?

Answer 8

Question 9

3 causes of renal hypertension?

Answer 9

Question 10

What are 7 common causes of endocrine hypertension, their potential indications for further workup and their typical findings?

Answer 10

Question 11

Other than renal and endocrine causes of secondary HTN, what are 3 other causes?

Answer 11

Question 12

What would you look for on examination?

Answer 12

Question 13

What are the clinical features of HTN?

Answer 13

Question 14

What are the cardiovascular complications of HTN?
What are the Brain complications of HTN?

Answer 14

Question 15

What are the renal complications of HTN?

Answer 15

Question 16

What are the opthalmic complications of HTN? Hypertensive retinopathy?
- 4 Grades?

Answer 16

Question 17

What does her retinal image show?

Answer 17

• Hard exudates
• Cotton wool spots
• Flame haemorrhages
• This is grade 3 hypertensive retinopathy. There are considerable hard exudate in the posterior pole with formation of a partial macular star.
• In grade 4 retinopathy optic disc swelling would also be present, but there is no evidence that clinical outcomes differ on the basis of the fundoscopic findings and both grade 3+4 should be regarded as indicators of hypertensive emergency.

Question 18

What treatment should be immediately instituted?

Answer 18

Question 19

Once BP has been initially lowered in a hypertensive crisis what should your management involve next?

Answer 19

Question 20

Discuss screening for hypertension:
- Indications?
- Method?

Answer 20

Question 21

How should hypertension be diagnostically confirmed?

Answer 21

Question 22

Which tests should be included in the Evaluation of patients with newly diagnosed hypertension?

Answer 22

Question 23

What is this investigation and what does it show?

Answer 23

Question 24

What are the First-line antihypertensive medications?

Answer 24

Question 25

What are the second line antihypertensive medications and their indications?

Answer 25

Question 26

Which Antihypertensive treatments should be used in patients with: - CKD? - Diabetes? - CHF? - Asthma?

Answer 26

Question 27

Discuss the Incidence, Risk Factors and Presentation of Hypertensive crises?

Answer 27

Question 28

What is the definitions of Hypertensive urgency? Hypertensive emergency?

Answer 28

* **Hypertensive urgency**: hypertensive crisis that is either asymptomatic or associated with isolated nonspecific symptoms (e.g., headache, dizziness, or epistaxis) without signs of acute organ damage * **Hypertensive emergency**: hypertensive crisis with signs of acute end-organ damage, mainly in the cardiovascular, central nervous, and renal systems

Question 29

List 6 causes of hypertensive crisis? - Which drugs?

Answer 29

Question 30

Hypertensive crisis management algorithm? Which drugs are most commonly used? (3)

Answer 30

The drugs most commonly used to treat hypertensive emergencies are nitroprusside, labetalol, and nicardipine. **Nitroprusside** = An intravenously administered, short-acting nitrate used to treat hypertensive crisis. Releases nitric oxide, which causes arterial and venous dilation. **Labetalol** = An adrenergic blocker with nonselective β antagonism (both β1 and β2 receptors) and some α1 antagonism. **Narcidipine** = A medium-acting dihydropyridine calcium channel blocker with a half-life of 8-12 hours commonly used in the management of hypertension, angina and supraventricular arrhythmias.

Question 31

Renal Artery Stenosis: - Epidemiology? - Aetiology?

Answer 31

Question 32

What is the pathophysiology of renal artery stenosis?

Answer 32

Question 33

Renal artery stenosis: - 6 Clinical features? - 8 Indications for imaging?

Answer 33

Question 34

Renal artery stenosis: - Imaging modalities? - 8 Indications for imaging? - Imaging findings? - 2 Lab ixs?

Answer 34

**Ixs - Lab** 1. Basic Metabolic Panel - Evidence of renal insufficiency (↑ serum creatinine, ↑ BUN, hyperkalemia) & Hypokalaemia (uncommon) 2. Urinalysis: Proteinuria may be present.

Question 35

Renal Artery Stenosis Treatment - Tx of associated hypertension? - Tx of atherosclerosis? - Surgical? Indications? 2 Options?

Answer 35