Hypertension
Explain that these are medicines for an illness, like those for hypertension or diabetes.
Treatment at a glance
- Amlodipine (calcium-channel blocker)
- ACE inhibitor or ARB (enalapril, losartan)
- Thiazide-like diuretic (hydrochlorothiazide)
What our notes say
- Explain that these are medicines for an illness, like those for hypertension or diabetes. (Introduction to Psychopharmacology)
- Hypertension (severe, or with vascular disease) is a contraindication because oestrogen raises the risk of stroke and heart attack. (Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 )
- CHA2DS2-VASc is at least 4 (age 65 to 74, female, hypertension, LV dysfunction), so anticoagulation is needed to prevent stroke from left atrial thrombus, and before and for 4 weeks after cardioversion. (Clinical Pharmacology I (MBPL 4400) main exam: 25 January 2023)
- Result: airflow obstruction, V/Q mismatch (hypoxaemia), hypercapnia in advanced disease, pulmonary hypertension and cor pulmonale. (Chronic Obstructive Pulmonary Disease (COPD))
- Long-term oxygen therapy (LTOT): for PaO2 below 7.3 kPa (55 mmHg), or 7.3–8 kPa with cor pulmonale, polycythaemia or pulmonary hypertension, used at least 15 hours a day; patient must not smoke. (Chronic Obstructive Pulmonary Disease (COPD))
- Examination: clubbing, fine bibasal crackles, skin or joint signs of CTD, signs of pulmonary hypertension and right heart failure. (Interstitial Lung Diseases)
Study material on Hypertension
- Hypertension
- CARDIOVASCULAR PATHOLOGY
- Cardiovascular system examination revised 2012
- CARDIOVASCULAR PATHOLOGY
- Junior Clerkship in Internal Medicine (MBIM4100) main exam, Paper One: 31 January 2024
- Lung Pathology — Must-Know
- Respiratory System Pathology 1A
- Heart Disease: Must Knows
- Endocrine & Renal Pathology
- Renal Vascular Diseases: Nephrosclerosis & Renal Artery Stenosis
- Cardiovascular syste.m yr 3 — Past Paper Questions & Answers
- Heart Disease: Must Knows
- Heart Disease: Must Knows
- Endocrine & Renal Pathology
- Endocrine & Renal Pathology
- Cardiovascular Pathology MCQs
Images
Practice questions on Hypertension
A 63-year-old woman has sudden 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR. CK is normal. What is the most likely diagnosis?
- Myocardial infarction
- Aortic dissection
- Pulmonary embolism
- Esophageal rupture
Answer: B. Sudden, severe, tearing chest pain radiating to the back, a history of hypertension, and a widened mediastinum on CXR are classic signs of aortic dissection. Normal CK rules out acute MI.
A 17-year-old short girl with absent puberty, webbed neck, upper extremity hypertension, diminished lower extremity pulses, and rib notching on CXR. What is the most likely cardiovascular abnormality?
- Coarctation of the aorta
- Tetralogy of Fallot
- Atrioventricular septal defect
- Pulmonary stenosis
Answer: A. This patient's presentation is highly suggestive of Turner syndrome (XO karyotype), which is frequently associated with coarctation of the aorta, characterized by upper extremity hypertension and diminished lower extremity pulses. Rib notching on CXR is a classic finding of coarctation due to collateral flow through intercostal arteries.
A 58-year-old male smoker with hypertension, crushing chest pain 2 hrs, ST-elevation in leads V1–V4. Which artery is MOST likely occluded?
- Right coronary artery (RCA)
- Diagonal branch of the LAD
- Left anterior descending artery (LAD)
- Posterior descending artery (PDA)
- Left circumflex artery (LCx)
Answer: C. - V1–V4 = anterior/anteroseptal leads → territory of the **LAD** - RCA → inferior leads (II, III, aVF); LCx → lateral leads (I, aVL, V5–V6) ---
A patient requires treatment for hypertension but also has asthma. Which antihypertensive should be AVOIDED?
- Non-selective beta-blockers
- ACE inhibitors
- Thiazide diuretics
- Calcium channel blockers
Answer: A. (like propranolol) can block β2-receptors in bronchial smooth muscle, causing bronchoconstriction and worsening asthma. Use cardioselective β1-blockers if needed. ---
A 63-year-old woman has sudden 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR. CK is normal. Most likely diagnosis?
- Aortic dissection
- Pulmonary embolism
- Myocardial infarction
- Esophageal rupture
Answer: A. Sudden onset severe chest pain radiating to the back, history of hypertension, and widened mediastinum on CXR are classic signs of aortic dissection. Normal CK rules out myocardial infarction. Esophageal rupture typically presents with more vomiting or retroperitoneal air.
A 17-year-old short girl with absent puberty, webbed neck, upper extremity hypertension, diminished lower extremity pulses, and rib notching on CXR. Most likely cardiovascular abnormality?
- Coarctation of the aorta
- Turner syndrome with bicuspid aortic valve
- Tetralogy of Fallot
- Pulmonary atresia
Answer: A. The combination of short stature, webbed neck, absent puberty (suggestive of Turner syndrome), and hypertension with diminished lower extremity pulses and rib notching (due to collateral circulation) strongly points to coarctation of the aorta. While Turner syndrome can have cardiovascular issues, coarctation is the primary cause of these specific findings.