amymed's version from 2015-10-06 20:40

Section 1

Question Answer
How do changes in systolic and diastolic blood pressures with age differ?Systolic rises throughout life. Diastolic rises until around 50, then stabilises and perhaps decreases a little
What systolic and diastolic numbers are considered to be hypertension?140/90
What is the most common type of hypertension?Essential hypertension (90+ per cent)
What is blood pressure the product of?Cardiac output and peripheral resistance
Name 4 factors that can affect blood pressure.Preload, contractility, vessel hypertrophy, peripheral constriction.
What is the grading of hypertension. State the values.High normal - 130/85-139/89. Stage 1: 140/90-159/99 Stage 2 160/100-179/109 Stage 3 180/110 +
Same some risk factors associated with developing hypertension.Age, high salt intake (reset in baroreceptors), family history, ethnicity (African/Caribbean), obesity, lack of exercise.
How might someone's 10 year risk of having a cardiovascular event be tested?QRISK2
Symptoms of hypertension?Headache, blurred vision, nosebleed, shortness of breath (pulmonary arterial hypertension?)
Key diagnostic factors of hypertension140/90, presence of risk factors, retinopathy
Other than the three main ones, what diagnostic factors suggest hypertension?Headache, visual disturbances, dyspnoea, chest pain, sensory/motor deficit.
What investigations would you perform to rule out secondary causes of hypertension?ECG, fasting metabolic panel with estimated GFR, fasting lipid panel, Hb, urinalysis.
What would unprovoked hypokalaemia suggest in a fasting metabolic panel?Possible hyperaldoesteronism.
How might Hb help in the diagnosis of hypertension?Anaemia accompanies chronic renal failure and polycythaemia can be indicitive of phaeochromocytoma
According to BMJ, what are the 5 most common differential diagnoses of hypertension?Essential hypertension, renal artery stenosis, chronic kidney disease, obstructive uropathy, obstructive sleep apnoea.
Name three vascular causes of hypertension. Coarctation of the aorta, pre-eclampsia, renal artery stenosis.
What is renal artery stenosis often caused by?Fibromuscular dysplasia or atherosclerosis.
What criteria are required in pregnancy to diagnose pre-eclampsia?Hypertension and proteinuria (without the second it is just gestational hypertension).
Name the 5 renal causes of hypertensionChronic renal disease, nephrotic syndrome, glomerulanephritis, obstructive uropathy, polycystic kidneys.
Name 6 endocrine causes of hypertension.Phaeochromocytoma (adrenal tumour with excessive adrenaline and NA), Hyperaldosteronism (Conn's), Cushing's, hyperthyroidism, hypothryoidism, hyperparathyroidis,
How would Cushing's affect BP?Increase it, due to high cortisol levels, which enhance vasoconstrictor effect of catecholamines
How might hyperthyroidism affect BP?Too much thyroxine exacerbates SNS, increasing vascular resistance and cardiac output.Can lead to isolated systolic hypertension.
How might hypothryoidism affect BP?Low levels of thryoid hormone cause a slow heart rate and peripheral vascular resistance occurs to compensate. Also elevates cholesterol and lipids in blood.
What toxic causes may result in hypertension?Chronic alcohol excess, oral contraceptives, NSAIDs, cocaine, amphetamine.
What sleep disorder is associated with hypertension?Obstructive sleep apnoea.
What is pseudo-hypertension? Apparent elevation of BP in clinical environments, often due to stress of anxiety at having the BP measured.
What might a delayed femoral pulse imply? aortic coarctation or aortic disease
A patient first presents with a BP of 150/95. What are your next steps?Take a second reading. Measure both arms. If still high after a third reading, offer ABPM, or HBPM.
How should HBPM data be collected and handled?Two consecutive measurements taken at least a minute apart with person seated, twice daily for at least 4 days. but preferably 7. DIscard first measurement and find an average of all remaining values.
How should ABPM data be collected and handlled?2 measurements per waking hour should be taken. An average of at least 14 measurements needed to confirm diagnosis.
Common complications of hypertension?LVH, cardiovascular disease, cerebrovascular disease, hypertensive retinopathy, nephropathy.
What causes the complications of hypertension?Remodelling of vessels, atherosclerotic changes
What is malignant hypertension?Sudden or sustained diastolic rise above 120mmHg, with accompanying damage to eyes, kidneys, brain or heart.

Section 2

Question Answer
What is step 1 treatment for a patient under 55 years?ACE-I or ARB
What is step 1 for patients over 55 years or patients who are black with African/Caribbean family origin?Calcium channel blocker - or thiazide-like diuretic if not tolerated
If a patient is currently on bendroflumethiazide, which is controlling hypertension well, how should treatment be continued?The same
Patient on bendroflumethiazide is having medication for hypertension changed, what should be given?Thiazide-like diuretic.
When might you consider the use of spironolactone and what are the associated risks?Step 4 of treatment. Risk of hyperkalaemia in patient with reduced GFR.
When might a beta-blocker be considered for hypertension?May be considered in young patients, particularly if there is increased sympathetic drive. May also be considered in women of child-bearing age or in people that cannot tolerate ACE-I or ARBs.
Name 5 types of drugs used in controlling hypertension.ACE-I. ARBs, CCB, Beta-blockers, Thiazide-like diuretics.
Which type of drug often results in a dry cough?ACE-I
Which type of drug is associated with oedema?CCB
What type of drug is Candesartan?ARB
What type of drug is Chlortalidone?Thiazide-like diuretic