Wk 13: Hypertension

Question 1

How is a patient treated if they have hypertension but no established CVD?

Answer 1

Primary prevention

Question 2

Should a BP be taken manually or using a machine?

Answer 2

Pulse irregularity = manually

Question 3

How do you measure blood pressure in people with symptoms of postural hypotension?

Answer 3

• Measure supine or seated
• Measure again standing for at least 1 min before measurement

Question 4

What happens if the blood pressure measured in the clinic is 140/90 mmHG or higher?

Answer 4

• Retake 2nd during consultation
• If 2nd different from 1st take 3rd
• Record lower of last 2 as clinic BP

Question 5

What happens if the blood pressure measured in the clinic is between 140/90 mmHG and 180/120mmHg?

Answer 5

Offer ABPM to confirm diagnosis of hypertension

Question 6

What do you do if the person is unable to tolerate ABPM or is unsuitable?

Answer 6

Offer HBPM to confirm diagnosis of hypertension

Question 7

What are readings of someone with blood pressure?

Answer 7

• Clinical 140/90 or higher

AND

• ABPM/HBPM daytime average 135/85 mmHg or higher

Question 8

What happens if hypertension is not diagnosed?

Answer 8

• Measure clinic BP every 5 yrs
• If close to 140/90 - more frequent

Question 9

What happens if an adult has type 2 diabetes without previously diagnosed hypertension or renal disease?

Answer 9

BP annually + lifestyle advice

Question 10

What are the lifestyle advice given to people with suspected or diagnosed hypertension?

Answer 10

• Diet + exercise
• Red alcohol intake
• Red coffee + caffeine rich prods
• Low sodium intake
• Don’t offer calcium, magnesium or potassium to red BP
• Smoking cessation

Question 11

What happens if a patient has severe hypertension (clinic BP 180/120 or higher) but no symptoms or same day referral?

Answer 11

Investigate target organ damage

• Identified: start antihypertensive immediatly w/o waiting results of ABPM/HBPM
• Not identified: repeat clinic BP w/in 7 days

Question 12

When do you refer?

Answer 12

Clinical BP 180/120 + higher w/:

• Retinal haemorrhage or papilloedema
• New onset confusion
• Chest pain
• HF
• AKI
• Pheochromocytoma

Question 13

What is offered to adults of any age with persistent stage 2 hypertension?

Answer 13

• Antihypertensives
• Lifestyle

Question 14

What would you offer an adult aged under 60 with stage 1 hypertension and estimated 10 year risk below 10%?

Answer 14

Antihypertensive + lifestyle advice

Question 15

What would you offer those aged over 80 with a clinic BP of >150/90?

Answer 15

Antihypertensive + lifestyle advice

Question 16

What are the BP targets for Age <80 years?

Answer 16

• Clinic BP <140/90 mmHg
• ABPM/HBPM <135/85 mmHg

Question 17

What are the BP targets for Age ≥80 years?

Answer 17

• Clinic BP <150/90 mmHg
• ABPM/HBPM <145/85 mmHg

Question 18

What is the target BP for patients with CKD?

Answer 18

• Systolic below 140
• Diastolic below 90

Question 19

What is the target BP for patients with CKD + diabetes, and ACR of > 70mg/mmol?

Answer 19

• Systolic below 130 (120-129)
• Diastolic below 80

Question 20

What are the BP targets for type 1 diabetes?

Answer 20

135/85

Question 21

What are the BP targets for type 1 diabetes w/ albuminuria or 2 features of metabolic syndrome?

Answer 21

130/80mmHg

Question 22

What is given to people with hypertension + type 2 diabetes?

Answer 22

• ACE/ARB
• • CCB or thiazide like diuretic
• ACE/ARB + CCB + Thiazide like diuretic

Question 23

What is given to people age <55 + not caribbean or african origin?

Answer 23

• ACE/ARB
• • CCB or thiazide like diuretic
• ACE/ARB + CCB + Thiazide like diuretic

Question 24

What is given to > 55 or african origin?

Answer 24

• CCB
• • ACE/ARB or thiazide like diuretic
• ACE/ARB + CCB + Thiazide like diuretic

Question 25

What do you give if the potassium levels are <4.5mmol/l?

Answer 25

Low dose spironolactone

Question 26

What do you give if the potassium levels are >4.5mmol/l?

Answer 26

Alpha blocker/betablocker