85 Questions
What is the trend in basing treatment for hypertension?
Using even lower thresholds for treatment
Where are the majority of patients with hypertension managed?
Primary care settings
What is the focus of renewed efforts on an international, national, and local scale?
Reduction of BP in hypertensive patients to target levels
At what age is hypertension rare?
Rare in children and adolescents
When is a diagnosis of hypertension in those under 30 years of age concerning?
It requires careful evaluation of possible underlying secondary causes
What does the text imply about the relationship between BP and cardiovascular disease?
There is a continuous relationship according to Figure 31.1
What are specialist hospital services usually reserved for in relation to hypertension?
Evaluation of secondary causes and problematic BP phenotypes
What does the text suggest about the reduction of BP to target levels in hypertensive patients?
It remains the focus of renewed efforts on an international, national, and local scale
What is the most easily detectable sign of early hypertensive kidney damage?
Increased microalbuminuria on urine test strips
What is the initial effect on glomerular filtration rate (GFR) associated with chronic blood pressure (BP)-lowering?
Reduction reflecting intra-renal haemodynamic changes
Why is it common practice to allow GFR to reduce by up to 10% on initiation of antihypertensive therapy?
To reduce the risk of progressive renal decline
What has meta-analyses of large-scale randomized controlled trials (RCTs) shown about the reduction in blood pressure (BP) and its association with all-cause mortality?
15% reduction in all-cause mortality
What modifiable cardiovascular risk factors are mentioned in the text as important to manage along with hypertension?
Raised cholesterol, diabetes mellitus, tobacco smoking, obesity
Why is treatment of hypertension without managing other modifiable cardiovascular risk factors considered suboptimal?
It may not effectively reduce major cardiovascular and renal events
What is the purpose of using cardiovascular risk scores such as QRISK2®?
To integrate modifiable risk factors for informed treatment decisions
What type of reduction in BP is associated with a 40% reduction in heart failure according to the text?
$10/5$ mmHg reduction
What is the relationship between age-related stiffening in large arterial structure and blood pressure (BP)?
Age-related stiffening in large arterial structure causes an increase in blood pressure throughout middle and later life.
How do female sex hormones influence blood pressure (BP) levels?
Women have lower BP levels at all ages due to the protective effect of female sex hormones until menopause.
Which ethnic groups are more prone to hypertension according to the text?
Black African and African–Caribbean
What is the primary symptom associated with hypertension as mentioned in the text?
Severe headaches
What is the effect of urbanization on hypertension prevalence according to the text?
Hypertension prevalence increases with urbanization.
What does the text suggest about the influence of migrant populations on hypertension prevalence?
Hypertension prevalence increases in migrant populations.
What role do symptoms related to raised blood pressure play in determining the need for treatment?
Symptoms related to raised blood pressure do not influence the need for treatment.
What happens to the prevalence of hypertension and achieved blood pressure levels in women after menopause?
After menopause, the prevalence of hypertension and achieved blood pressure levels approximate those of men.
What is the main reason for intraoperative hypertension, according to the text?
Inadequate analgesia
Why are ACEIs and ARBs often withheld arbitrarily for 24 hours preoperatively?
To prevent intraoperative hypertension
What is the usual approach to antihypertensive medications throughout the perioperative period?
Continuing unless there is documented hypotension
What is the most common reason for postoperative hypertension, as mentioned in the text?
(Inadvertent) omission of antihypertensive medications
What is a risk factor for myocardial ischemia and injury in the context of intraoperative blood pressure lability?
Untreated hypertension
What can sympathetic activation during induction of anesthesia cause in terms of blood pressure?
$30$ mmHg elevation in BP
What tends to happen to blood pressure with maintenance of anesthesia?
It tends to fall due to the direct sympatholytic and vasodilating actions of anesthetic drugs
What is the recommended action in case of intraoperative hypertension?
Exclude serious problems with airway, oxygen delivery, and breathing first.
What is the trend in hypertension treatment mentioned in the text?
Using total cardiovascular risk to guide treatment decisions
Where are specialist hospital services usually reserved for in relation to hypertension?
Evaluation of secondary causes
What is a key focus of renewed efforts on an international, national, and local scale according to the text?
Promoting management of hypertension to target levels
Why are specialist hospital services usually reserved for evaluation of secondary causes in hypertension?
To manage problematic BP phenotypes and medication intolerances
Why is diagnosis of hypertension in those under 30 years of age concerning, as mentioned in the text?
To evaluate possible underlying secondary causes
What is the relationship between female sex hormones and blood pressure levels?
Female sex hormones protect against raised blood pressure until menopause.
What is the trend in the prevalence of hypertension in certain ethnic groups mentioned in the text?
Hypertension is more common in black African and African–Caribbean ethnic groups.
What happens to the prevalence of hypertension and achieved blood pressure levels in women after menopause?
Both the prevalence of hypertension and achieved blood pressure levels increase.
How does age-related stiffening in large arterial structure affect blood pressure?
It leads to an increase in blood pressure throughout middle and later life.
What is the effect of urbanization on the prevalence of hypertension, as mentioned in the text?
The prevalence of hypertension increases with urbanization.
What percentage of the adult population does hypertension affect, as mentioned in the text?
One-third
Which medical specialties may doctors subspecialize in for the management of hypertension, according to the text?
Clinical Pharmacology
What is the leading risk factor for death worldwide, as stated in the text?
Raised blood pressure (BP)
What is the primary focus of renewed efforts on an international, national, and local scale, according to the text?
Managing cardiovascular risk factors
Where is most hypertension managed, as mentioned in the text?
Primary care
In hypertensive emergencies, what is the key factor in determining the severity of organ injury?
The rate and magnitude of any increase in blood pressure
In hypertensive emergencies, what is the purpose of intravenous antihypertensive medication therapy?
To reduce the risk of morbidity and mortality
When is referral to specialist secondary care mandated, according to the text?
When the patient has resistant hypertension with three drugs
What is the preferred approach for managing hypertensive patients in primary care?
Titration of standard chronic therapies with on-going monitoring
What is the role of short-acting drugs like sublingual glyceryl trinitrate (GTN) or nifedipine in managing hypertensive emergencies?
There is no role for them, and titration of standard chronic therapies with on-going monitoring is preferred
What is the primary purpose for conducting ECGs in all hypertensive patients, as mentioned in the text?
To detect any evidence of organ injury due to hypertension
What is the key limitation that affects the wide utility and acceptance of cardiac imaging modalities using transthoracic echocardiography and cardiac MRI in all hypertensive patients?
Limited access and high cost
What is the significance of kidney disease in relation to hypertension, as mentioned in the text?
Kidney disease is both a cause and a consequence of hypertension
Why are ECGs recommended in all hypertensive patients, according to the text?
To detect any evidence of organ injury due to hypertension
What is the primary purpose of drug therapy advocated in the text after a 3–12-month period of best-tolerated lifestyle changes?
To normalize the office BP to less than 140/90 mmHg
What is the purpose of the clinical assessment of patients with hypertension according to the text?
To determine the impact of lifestyle factors such as drug use, tobacco smoking, exercise, and stressors
Why is the measurement of blood pressure considered inherently imprecise according to the text?
Because a single measure may not reliably represent the usual (real) blood pressure and its contribution to overall cardiovascular risk
What is the key factor that determines the cause of adverse symptoms in patients receiving antihypertensive therapy?
Postural intolerance
What should be covered in the history of patients with hypertension according to the text?
Tobacco smoking, exercise, and stressors (work and personal)
What is represented by two numbers when measuring blood pressure according to the text?
Systolic pressure/diastolic pressure in mmHg
Which condition is hypertension a leading risk factor for?
Atrial fibrillation
What is the most common chronic health condition for which patients receive medication from their primary care doctor?
Hypertension
What percentage of adults does hypertension affect?
One-third
What are modern drug therapies licensed for cardiovascular protection based on?
Sustained BP reduction
What are the annual drug costs related to hypertension well in excess of in the UK?
$1 billion
Against what evidence is hypertension diagnosed?
Blood pressure threshold levels from large multicentre studies
What is the leading risk factor for end-stage kidney disease?
Hypertension
What percentage reduction in heart failure is associated with a reduction in blood pressure?
$40%
What are patients with hypertension managed mainly by?
Primary care doctors
What is the expected mean reduction in blood pressure (BP) associated with regular cardiovascular exercise for 30 minutes daily?
5 mmHg
In the context of weight reduction for overweight individuals, what is the expected mean reduction in blood pressure (BP) per kilogram of weight lost?
1 mmHg
What is the expected mean reduction in blood pressure (BP) associated with increased intake of fruits and vegetables and reduced intake of saturated fat?
10 mmHg
What is the expected mean reduction in blood pressure (BP) associated with dietary salt reduction?
10 mmHg
Based on the text, what blood pressure readings are associated with greater perioperative harm?
>180/110 mmHg
What is the reason for commonly referring patients back to their primary care doctor for adequate management of hypertension prior to elective procedures?
>180/110 mmHg
In the context of uncontrolled blood pressure (BP), what readings indicate evidence of chronic poor control in treated patients?
>160/100 mmHg
What is the primary purpose of keeping doses to a minimum and combining different classes of medication for hypertension treatment?
To minimize adverse effects and maximize the likelihood of effectively lowering BP
What is increasingly recognized as a key barrier to achieving blood pressure control?
Adherence
Which validated measure is mentioned in the text for assessing adherence to medication treatment?
Morisky-8 Medication Treatment
What is the most likely effect of severe hypertensive retinopathy on the eyes, based on the description provided in the text?
Signs of malignant hypertension causing optic disc swelling
What is the significance of cotton-wool spots in moderate hypertensive retinopathy?
Suggest a severe stage of retinopathy
What is the primary purpose of the examples provided for hypertensive retinopathy in the text?
To provide examples of severe retinopathy stages
What is the likely effect of arteriovenous nicking and focal narrowing in mild hypertensive retinopathy?
Suggest an early stage of hypertensive retinopathy
Test your knowledge on the assessment of early hypertensive kidney damage through urine test strips, laboratory albumin:creatinine ratio, and estimates of glomerular filtration rate (GFR). Explore the impact of antihypertensive medications and chronic blood pressure-lowering on GFR.
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