SNAP SAMP (Answers Below):
A 24 year-old female presents to you with a blood pressure of 150/90…
Name 4 causes of secondary hypertension
Assuming you diagnose new hypertension in this patient, what initial investigations would you order for this patient (name at least 5)?
Name 1 CLASS of medication that you should avoid in this patient
Name 2 examples of hypertensive emergency
Hypertension is a NEED-TO-KNOW TOPIC
Here are some tips to remember:
DO screen all patients at all appropriate visits
Automated cuffs are BETTER than your manual skills (NEW in the CHEP guidelines)
DO NOT use ACEi as first line therapy in Black patients with uncomplicated HTN
DO NOT use beta-blockers in patients >60 with uncomplicated HTN
On a SOO, always ask about medication compliance and educate the patient on how to check their BP at home
KNOW YOUR TARGETS!
<140/90 for uncomplicated patients
<130/80 for DM or CVD
<140/90 for renal patients (who are non-diabetic)
<150 SBP in patients over 80
Remember your lifestyle modifications! Can you list FIVE without looking?
Decrease Sodium (reduce by 1800mg/day)
Lose weight (4.5kg)
Reduce Alcohol (by 2.7 drinks/day)
Exercise! (150min/week)
Change that diet (DASH = Dietary Approaches to Stop Hypertension)
The CHEP guidelines are Canada’s hypertension guideline, so make sure to review these guidelines carefully before your exam!
A 24 year old female presents to you with a blood pressure of 150/90…
Name 4 causes of secondary hypertension
Obstructive Sleep Apnea
Hyperaldosteronism
Pheochromocytoma
Renal Artery Stenosis
Hyperthyroidism
Cushings Syndrome
Don’t forget that medications such as OCP and NSAIDS can raise BP, so definitely ask about them on a SOO
Assuming you diagnose this patient appropriately with new hypertension, what initial investigations would you order?
BETA HCG! Although this is not part of the initial workup for hypertension, if this patient is pregnant, it changes the way we will manage her!
Urinalysis
Potassium (remember, “electrolytes” alone isn’t specific enough according to the CCFP)
Sodium
Creatinine
Fasting Blood Glucose / Or Glycated Hemoglobin A1c (remember, “glucose” alone might not be specific enough!)
Serum Total Cholesterol (remember, do not write “lipid profile” and new for 2016, you no longer need to ask your patients to fast!)
Low-Density Lipoprotein
High-Density Lipoprotein
Triglycerides
Non-HDL cholesterol
12-lead electrocardiography
Urinary Albumin excretion (if diabetic)
Name 1 CLASS of medication that you should avoid in this patient.
AVOID ACEi (in case she is pregnant)
Name 2 examples of Hypertensive emergency
Pre-eclampsia
Acute ischemic stroke
Acute kidney injury
Acute coronary syndrome
Acute aortic dissection