HTN and Associated Changes

Question 1

What is HTN in terms of BP cutoffs?

Answer 1

BP >140/90
UNLESS:
-DM: >130/80
-80y+: >150/90

Question 2

What is accelerated HTN?

Answer 2

Significant recent increase in BP over previous hypertensive levels associated with evidence of vascular damage on fundoscopy but without papilloedema

Question 3

What is malignant hypertension?

Answer 3

High enough BP to cause papilloedema and other manifestations of vascular damage (retinal haemorrhages, bulging discs, mental status changes, increasing Cr).
Often BP >200/140

Question 4

What is the aetiology of HTN?

Answer 4

• Essential /Primary HTN
• Secondary HTN
• White coat HTN

Question 5

Factors predisposing to HTN?

Answer 5

• Male
• 30y+
• High salt diet
• Smoking
• Obesity
• Sedentary lifestyle
• Stress
• Dsylipidemia

Question 6

Renal causes of secondary HTN?

Answer 6

• Renovascular HTN

- Renal parenchymal disease / glomerulonephritis / pyelonephritis / polycystic kidney disease

Question 7

Endocrine causes of secondary HTN?

Answer 7

• 1” hyperaldosteronism
• Phaeochromocytoma
• Cushing’s syndrome
• Hyperthyroidism / hyperparathyroidism
• Hypercalcemia of any cause

Question 8

Vascular causes of HTN?

Answer 8

• Coarctation of the aorta

- Renal artery stenosis

Question 9

Causes of secondary HTN?

Answer 9

ABCDE
Apnea, Aldosteronism
Bruits, Bad Kidneys
Coarctation, Cushings, Catecholamines, Calcemia
Drugs
Endocrine Disease

Question 10

Ix in all pts w/ HTN?

Answer 10

• FBE: anemia CKD
• UEC: esp K+ (high in renal disease, low in aldosteronism)
• LFTs: fatty liver/ drug rxn
• Urine Alb:Cr ratio: evidence renal damage
• Fasting BSL
• Lipids
• ECG: CAD / hypertrophy
• Urinalysis

Question 11

Lifestyle Mx HTN?

Answer 11

• Diet
• Moderate Exercise
• Smoking cessation
• Stress Management
• Low risk alcohol consumption
• Healthy BMI

Question 12

Pharmacological Mx HTN?

Answer 12

-ACEi, ARB
-B blocker
-CCBs
-Diuretics
If partial response to standard monothearpy, add another first line drug in 2-3/52.
Step 1: A / C / D
Step 2: A+C / A+D
Step 3: A+C+D

Question 13

What does HTN predispose to?

Answer 13

• CAD
• Stroke
• Cardiac hypertrophy
• CCF
• Renal failure

Question 14

Is a person’s avg BP ass/w CV risk?

Answer 14

Yes- relationship between BP and CV risk is continuous. Above 115/75mmHg, for each 20mmHg SBP increase CV/stroke risk doubles.

Question 15

How is diagnosis of HTN made?

Answer 15

INITIAL
BP >140/90mmHg
After 5 minutes seated rest
2 readings, 2mins apart.
REVIEW
-Additional visit 1-4/52
-24hour ambulatory measures
-Home BP measures

Question 16

Important features to elicit in HTN Hx?

Answer 16

• FHx
• PHx: CV / stroke events
• HF Sx
• Renal disease symptoms
• Smoking
• DM
• High cholesterol

Question 17

Examination features in HTN?

Answer 17

• Pulse rate and rhythm
• BMI
• Full CV exam
• Renal bruits / masses
• Stigmata secondary causes

Question 18

When should BP be treated?

Answer 18

SBP >180
DBP >110
normal pt, no other RFx

Question 19

When should BP + risk be treated?

Answer 19

SBP >140
DBP >90
PLUS DM, CV / renal disease OR high CV risk

Question 20

What are the high CV RFx?

Answer 20

• Age
• SBP
• Total:HDL cholesterol ratio
• Smoking
• DM
• End organ damage

Question 21

What is the end organ damage indicative of high CV risk?

Answer 21

• Microalbuminuria / low eGFR (renal damage)
• LV hypertrophy (cardiac damage)
• High pulse wave velocity (stiff large arteries)
• Increase intimal-media thickness (reflects atherosclerosis).

Question 22

Considerations of ACEi/ARBs as first line choice in Mx HTN?

Answer 22

-Preferred if

Question 23

Evaluation of “resistant HTN”

Answer 23

Usually poor compliance.

• Consider spiro, B-blocker, centrally acting agent, a-blocker or vasodilator
• Question compliance
• Check for NSAIDs, cold remedies, antidepressants etc
• ?Secondary HTN causes