Return to Scenario ListShow Learning Points most relevant to Phase 1:

Secondary hypertension

Clinical Discipline(s)/Organ System(s)
Endocrinology, General Practice, Renal Medicine, Obstetrics & Gynaecology
Progress Test Topic(s)
A 35 year old NZ European woman visits her GP as she wants to start the oral contraceptive pill. You are asked to take her blood pressure and it is 180/105 mmHg. The GP looks back through her records and notes that her blood pressure was as high as this last time she came for an insurance medical.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Determine blood pressure, pulse pressure and mean arterial pressure
   - Pathophysiology of hypertension
   - Pharmacology of beta adrenoceptor blocking drugs, alpha adrenoceptor blocking drugs, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists, spironolactone, thiazide diuretics
   - Anti-hypertensive drugs that are safe in early pregnancy
Clinical and Communication Skills 
   - Elicit a history from a young patient with hypertension; family history and history of hypertension in pregnancy
   - Recognise risk factors for secondary causes of hypertension; recognise the Cushingoid patient
   - Examine the hypertensive young patient
   - Recognise end organ damage and malignant hypertension
   - Differential diagnosis of secondary hypertension
   - Interpret investigations for secondary hypertension: 24 hour urine collection for cortisol, serum renin:aldosterone ratio, serum metanephrines
   - Indications for pregnancy test, dexamethasone suppression tests, MR angiography and renal ultrasound
   - Use ambulatory blood pressure monitoring to exclude white coat hypertension
   - Management of essential hypertension
   - Consider contraceptive needs for women of reproductive age with hypertension
   - Indications for surgical management of secondary hypertension
   - Recognise importance of pre-conceptual counselling and interdisciplinary care in pregnancy for women with hypertension
   - Outline management of malignant hypertension
   - Complications of malignant hypertension
Personal and Professional Skills 
   - Supporting patients to self-manage conditions with no symptoms
   - Discussion of absolute risk and drug side-effects
   - Communication of primary and secondary prevention to patients and whānau considering health literacy needs
   - Respect for autonomy and professional integrity
   - Patient rights and requests for treatment
Hauora Māori 
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
   - Access to kaupapa Māori services
Population Health 
   - Epidemiology of essential hypertension and gestational hypertension
   - Epidemiology of secondary hypertension
   - Understand different epidemiology of cardiovascular disease for Māori, Pacific and South Asian peoples
Conditions to be considered relating to this scenario
essential hypertension, obstructive sleep apnoea, combined oral contraceptive pill use, atherosclerotic renal artery stenosis, alcohol abuse/dependence, white coat hypertension, chronic kidney disease, gestational hypertension
Less common but 'important not to miss'
phaeochromocytoma, Cushing's syndrome, primary hyperaldersteronism
liquorice use, coarctation of the aorta, autosomal dominant polycystic kidney disease, fibromuscular dysplasia