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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.

On this page - questions about this scenario
At the foot of this page - Hypertension guidelines, and secondary causes info
On the next page - About the different types of treatment.

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