2- management of hypertension

Question 1

does weight loss help with hypertension?

Answer 1

yes - 1 mmHg for every kg (works for adding kg or losing kg)

Question 2

does reduced salt help manage hypertension?

Answer 2

yes - no salt added diet reduces blood pressure by 2-4 mmHg

Question 3

does calcium, magnesium , potassium or combination supplements help management of hypertension?

Answer 3

no = no evidence of blood pressure benefit

Question 4

does everyone benefit from BP and cholesterol lowering?

Answer 4

yes (to an extent i think?) - high risk normotensives with “normal” cholesterol benefit from BP & cholesterol lowering

Question 5

what is the steps of drugs you should give for someone less then 55 years old?

Answer 5

Step 1: Offer an ACE inhibitor or ARB.

Step 2: In addition to an ACE inhibitor or ARB, add in a calcium channel blocker or thiazide-like diuretic. Offer a thiazide-like diuretic if there is evidence of heart failure. For full guidance on the management of chronic heart failure, see Chronic heart failure.

Step 3: Offer an ACE inhibitor or ARB, a calcium channel blocker and a thiazide-like diuretic.

Question 6

what drugs you should give someone who is 55 or older or black patient of any age?

Answer 6

Step 1: Offer a calcium channel blocker.

Step 2: In addition to a calcium channel blocker offer an ACE inhibitor, ARB or a thiazide-like diuretic.

Step 3: Offer an ACE inhibitor or ARB, a calcium channel blocker and a thiazide-like diuretic.

Question 7

what drugs are preferred with adults who are black-african or african-caribbean family origin?

Answer 7

calcium blocker & diuretic

• prefer ARB over ACEi

Question 8

what are renin levels like in young & old people?

Answer 8

young people = have high renin and benefit from suppressors

old people = have low renin and benefit from stimulating renin

(renin is in RAAS pathway, more renin →increases blood pressure)

Question 9

what drug is good for angina & ischaemic heart disease?

Answer 9

beta blockers

Question 10

what drugs are good for heart failure?

Answer 10

4 pillars = ARNI, beta blockers, mineralocorticoid antagonists, SGLT2 inhibitors

Add ons = Digoxin ( blocks AV conduction) or diuretics (to help oedema, breathlessness)

Question 11

what drugs are good for diabetic nephropathy?

Answer 11

diabetic nephropathy = complication of diabetes that affect kidneys

• ACE inhibitors & ARBs

Question 12

what drugs are good for prostatism?

Answer 12

prostatism = symptoms related to enlarged prostate (old term)
alpha blockers

Question 13

what hypertension drugs are good for the elderly?

Answer 13

thiazides

Question 14

what are beta blockers good for?

Answer 14

arrhythmias, coronary artery disease, increased sympathetic activity, congestive heart failure

(and young females)

Question 15

what is first line of drug for hypertension in under 55?

Answer 15

ARBs then ACE inhibitor

Question 16

is it better to add a drug or increase a dose for hypertension drug treatment?

Answer 16

adding a drug is 5x more effective than titrating (adding dose)

Question 17

what is a polypill?

Answer 17

multiple drugs in 1 tablet (can be expensive and difficult to sell/make)

Question 18

what is good about combination therapy?

Answer 18

= more effective than mono-therapy

• also fewer side effects with combination

Question 19

what makes hypertension resistant hypertension?

Answer 19

• non-concordance (patient not compliant with doctor)
• white coat effect (should check at home as might not be as bad in day to day life)
• lifestyle factors (like cocaine or bad lifestyle)
• drug interactions (NSAIDs like ibuprofen stop diuretics working)
• secondary hypertension (high blood pressure caused by identifiable and often treatable underlying condition)
• true resistance (they actually have resistant hypertension)

Question 20

when should spironolactone be prescribed?

Answer 20

• it’s the most effective treatment for resistant hypertension
• patients should not be defined as resistant hypertension unless their BP remains uncontrolled by spironolactone
• you have to start low and go slow as it can be safe but only with adequate monitoring

Question 21

what is renal denervation?

Answer 21

minimally invasive procedure designed to treat resistant hypertension

= The procedure involves using radiofrequency energy or ultrasound to disrupt nerve pathways that contribute to the regulation of blood pressure in the kidneys. The goal is to reduce the activity of these nerves, leading to lower blood pressure

Question 22

what is carotid baroreceptor stimulation?

Answer 22

= medical intervention in treating hypertension

• small device that sends electrical signals to trick brain that there is high blood pressure therefore wanting to lower BP