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Hypertension tutorial

Educational resources for renal medicine

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Hypertension tutorial

This tutorial is based around a case and covers diagnosis, investigation and simple management.

A 45 year old man is referred with high blood pressure. The letter referring the patient provides the details that, on a routine work assessment check, the patient was found to have a BP of 165/95 and this was confirmed a week later at his GP's surgery. A recheck BP today is also elevated at 170/97.

 

Question 1

Do you think that the diagnosis of hypertension is valid?

Think first ... then hover over the answer
 

Question 2

Do you think that he needs a 24 hour Ambulatory BP monitor?

Think first ... then hover over the answer

 

Question 3

What details do you think are important to find out from the patient?

See if you can choose the 3 most important.

Hover over select for feedback

  1. Does he have a history of high BP and has it ever been checked before?  select
  2. Does he have pounding headaches?  select
  3. Does he have a heart murmur?  select
  4. How many ready meals does he eat?  select
  5. Does he have any other history of ischaemic heart disease or diabetes?  select

  

Question 4

What is the most likely cause of hypertension in this man?

Make a note of what you think... then hover over the answer to see what we thought.

 

Question 5

Do you know any causes of secondary hypertension?

Write down two important causes, and two rare ones, before clicking the answer at the foot of this page. 



Question  6

What exacerbating factors are important in hypertension?

Hover over select for feedback

  1. Obesity  select
  2. Low calcium intake  select
  3. Low exercise  select
  4. Alcohol  select
  5. Smoking  select
  6. NSAIDs  select
  7. Salt intake  select

  

Question 7

What symptoms/signs of end organ damage should be sought?

How many do you think?

Hover over select for feedback

  1. Blood in the urine select
  2. Protein in the urine  select
  3. Shortness of breath  select
  4. Diabetes mellitus select
  5. History of TIA/stroke  select
  6. Eye changes  select
  7. Peripheral neuropathy select

  

Question 8

What treatment would you advise for this patient (Young male - Abg BP 168/95)?

Hover over select for feedback

  1. Combination of ACE inhibitors and thiazides select
  2. ACE inhibitors select
  3. Lifestyle modification x 3 months select
  4. Thiazides select
  5. Beta blocker select

  

 

Question 9

What aspects of lifestyle modification would you advocate? (At least 3 or 4 of these are not necessary, or counter-productive).

Hover over select for feedback

  1. Low fat diet  select
  2. Low sodium diet  select
  3. Weight loss  select
  4. Isometric exercise  select
  5. Use of garlic  select
  6. Stop smoking  select
  7. Cut down alcohol consumption  select
  8. Get a haircut  select
  9. Change job  select
  10. Increase fruit & veg intake  select

 

On the next page, info about the different classes of anti-hypertension drug, and questions on their use.  Below you can revise the secondary causes of hypertension and see a summary of the NICE guidelines.  

 

Further info:
Revision:  Causes of secondary hypertension (click here to show/hide)
Summary of NICE guidelines (click here to show/hide)
 
Page last modified 13.08.2015, 12:08 by Administrator. edrep and edren are produced by the Renal Unit at the Royal Infirmary of Edinburgh and Univ. Edinburgh. CAUTIONS and Contact us. Note that the information published here is primarily intended for education, not for clinical care.