Diagnosis

Question 1

What is HTN a risk factor for?

Answer 1

• Stroke
• IHD
• HF
• CKD
• Cognitive decline
• Premature death

Question 2

When would you measure BP manually?

Answer 2

if pulse irregularity is present

Question 3

When would you take a second BP measurement?

Answer 3

• If the difference in readings between arms is more than 15 mmHg
• If BP measured in the clinic is 140/90 mmHg or higher

Question 4

Which measurements of BP do you record?

Answer 4

The lowest 2

Question 5

When would you offer ABPM or HBPM?

Answer 5

Patient’s BP is between 140/90 mmHg and 180/120 mmHg

Question 6

When using HBPM, what is the advice given?

Answer 6

• Stay seated
• Take 2 consecutive measurements, as least 1 minute apart
• Record in the morning and at night
• Want 14 measurements (7 days)

Question 7

How would you diagnose HTN from HBPM?

Answer 7

Discard the measurements taken on the first day and use the average value of all the remaining measurements

Question 8

What is a diagnosis of HTN?

Answer 8

• Clinic BP of 140/90 mmHg ≥
AND
• ABPM or HBPM average of 135/85 mmHg ≥

Question 9

What tests would you offer to a patient with newly diagnosed HTN?

Answer 9

• Urinalysis
• HbA1C, U+Es, creatinine, eGFR, total cholesterol and HDL cholesterol
• Fundoscopy
• ECG

Question 10

What are the clinic BP aims?

Answer 10

• <80 = ≤ 140/90 mmHg

* >80 = ≤ 150/90 mmHg

Question 11

What are the BP aims for ABPM and HBPM?

Answer 11

• <80 = <135/85 mmHg

* >80 = <145/85 mmHg

Question 12

What are the stages of HTN?

Answer 12

STAGE 1
135/85 - 149/94

STAGE 2
150/95 - 179/119

STAGE 3
>180/120

Question 13

What is a hypertensive urgency?

Answer 13

BP is >180/110

No acute damage to kidneys, heart or brain

Question 14

What is a hypertensive emergency?

Answer 14

BP is >180/120

Damage to end organs

Question 15

What are the symptoms of a hypertensive urgency?

Answer 15

o Severe headache
o SOB
o Epistaxis
o Anxiety

Question 16

What are the symptoms of a hypertensive emergency?

Answer 16

o	Chest pain
o	SOB
o	Back pain
o	Numbness and weakness
o	Changes in vision
o	Difficulty speaking
o	Encephalopathy

Question 17

How would you manage a hypertensive emergency?

Answer 17

IV meds:

• Vasodilator
• CCB
• Beta-blocker

Question 18

Who is at most risk of heart disease and stroke?

Answer 18

• CKD 3, 4, 5
• Migraine
• Corticosteroids
• Systemic lupus erythematous (SLE)
• Atypical antipsychotics
• Severe mental illness
• Erectile dysfunction
• A measure of systolic BP variability

Question 19

What is a Q-RISK3 score?

Answer 19

Identifies who is at most risk of heart disease and stroke

Question 20

What Q-RISK3 score is the treatment threshold for prevention of CVD?

Answer 20

10%

Question 21

In which patients would you not use a Q-RISK3 score?

Answer 21

• T1DM
• eGFR <60
• Albuminuria
• Familial hypercholesterolaemia

Question 22

What advice should you give for prevention of CVD?

Answer 22

• Eat a cardioprotective diet
• At least 150 mins of moderate or 75 mins of vigorous intensity exercise per week
• Reduce alcohol consumption
• Smoking cessation
• Treatment with statins

Question 23

What lipid measurements would you take to assess for CVD?

Answer 23

• Total cholesterol
• HDL cholesterol
• Non-HDL cholesterol
• Triglyceride concentrations

Question 24

When would you consider the possibility of familial hypercholesterolaemia?

Answer 24

• Total cholesterol conc >7.5mmol/l and

* Family Hx of premature coronary heart disease

Question 25

What treatment would you give for primary prevention of CVD?

Answer 25

• 20mg atorvastatin o.n.

Question 26

Who would you give primary prevention treatment to for CVD?

Answer 26

- Patients that have not have CV disease in the past - 10% or greater 10-year risk of developing CVD - Have CKD or T1DM for >10yrs

Question 27

What do you check after giving primary prevention for CVD?

Answer 27

Lipids - 3 months - Aim for >40% reduction in non-HDL cholesterol LFTs - 3 months, 12 months - Need to stop if AST and ALT rise 3X above upper limit of normal

Question 28

Who would you give secondary prevention to for the treatment of CVD?

Answer 28

Patients that have had angina, MI, TIA, stroke or peripheral vascular disease

Question 29

What treatment would you give for secondary prevention of CVD?

Answer 29

• 80mg atorvastatin o.n.

Question 30

What are the side-effects of statins?

Answer 30

* Myopathy * T2DM * Haemorrhagic stroke

Question 31

For a hypertensive emergency, when would you use Nitroglycerin (GTN) IV?

Answer 31

If patient has co-existant coronary ischaemia or HF

Question 32

Who would you NOT give labetalol to for a hypertensive emergency?

Answer 32

- Asthma - Metabolic acidosis, - Phaeocromocytoma - Angina - AV block - HF

Question 33

Why should you lower the BP gradually most of the time in a hypertensive emergency?

Answer 33

Ischaemic damage may occur in organs that have become accustomed to higher pressures (due to ‘autoregulation’). An excessive hypotensive response is potentially dangerous, and may lead to ischaemic complications such as stroke, myocardial infarction, or blindness.

Question 34

How much should you normally reduce the BP by in a hypertensive emergency?

Answer 34

20% in first hour | 5-15% over next 23 hours

Question 35

When would you lower the BP rapidly in a hypertensive emergency?

Answer 35

Aortic dissection

Question 36

When would you not lower the BP in a hypertensive emergency?

Answer 36

Acute phase of ischaemic stroke | Not lowered unless >185/110 mmHg