20) Hypertension and Heart Failure

Question 1

What diseases can hypertension be secondary to?

Answer 1

Renovascular disease
Conn’s syndrome
Cushing’s syndrome
Co-arctation of the aorta

Question 2

Describe the grades of hypertension:

Answer 2

Grade 1: 140-159, 90-99
Grade 2: 160-179, 100-109
Grade 3: >180, >110

Question 3

What lifestyle advice can be offered to those with hypertension?

Answer 3

Reduce body weight
Limit salt and alcohol
Regular activity
Eat fruit and veg

Question 4

What is the 1st line treatment for hypertension?

Answer 4

ACEi/ARB

Ca2+ channel blockers, thiazides

Question 5

Give examples and the mechanism of action of ACE inhibitors:

Answer 5

Lisinopril, ramipril

Inhibits ACE to reduce angiotensin || levels

Question 6

What are the effects of ACE inhibitors on the body?

Answer 6

Arteriolar vasodilation, venodilation, less aldosterone, less sympathetic stimulation

Question 7

What are the side effects of ACE inhibitors?

Answer 7

Dry cough
Angio-oedema (black pop.)
Renal failure
Hyperkalemia

Question 8

Give examples and the mechanism of action of angiotensin receptor blockers:

Answer 8

Lorsatan, valsartan

Blocks AT1 receptor

Question 9

What are the effects of angiotensin receptor blockers on the body?

Answer 9

Inhibits vasoconstriction and aldosterone stimulation by ATII

Question 10

What are the side effects of angiotensin receptor blockers?

Answer 10

Renal failure, hyperkalemia

Question 11

What are the 3 main groups of calcium channel blockers?

Answer 11

Dihydropyridine, benzothiazepines, phenylalkylamines

Question 12

What are the effects of dihydropyridine on the body?

Answer 12

Vasodilate peripheral, coronary and pulmonary arteries

Question 13

What are the side effects of dihydropyridine?

Answer 13

Tachycardia, flushing, sweating, headache, oedema, gingival hyperplasia

Question 14

What are the effects of phenylalkylamines on the body?

Answer 14

Peripheral vasodilation and reduces myocardial contractility

Question 15

What are the side effects of phenylalkylamines?

Answer 15

constipation, bradycardia, worsen HF

Question 16

What are the effects of benzothiazepines on the body?

Answer 16

Prolongs AP, peripheral vasodilation and reduces myocardial contractility

Question 17

What are the side effects of benzothiazepines?

Answer 17

Bradycardia, worsen HF

Question 18

What are the side effects of thiazides?

Answer 18

Hypokalemia, hyperuricemia, impaired glucose tolerance, increased cholesterol

Question 19

What do NICE guidelines recommend as the first choice drugs for hypertension based on age?

Answer 19

<55 yrs: ACEi/ARB

>55 yrs/black: CCB or thiazide

Question 20

What are some examples of other second line anti-hypertensives?

Answer 20

Alpha blockers
Beta blockers
Aliskiren
Central acting agents
Vasodilators

Question 21

What are the side effects of alpha adrenoreceptor blockers?

Answer 21

Postural hypotension
Dizziness
Headache
Fatigue
Oedema

Question 22

What are the side effects of beta blockers?

Answer 22

Lethargy
Bradycardia
Cold hands
Impaired glucose tolerance

Question 23

What is the mechanism of action of aliskiren?

Answer 23

Binds to renin to block cleavage of angiotensinogen to angiotensin I

Question 24

When is aliskiren contraindicated?

Answer 24

Pregnancy

Question 25

What is aldosterone escape?

Answer 25

In spite of ACEi/ARB, aldosterone release returns to normal n HF due to salt and water retention

Question 26

What are the first line treatments in heart failure?

Answer 26

ACEi/ARB
Beta blockers
Spironolactone
Hydralazine

Question 27

What are the complications of hypertensive emergencies?

Answer 27

Pulmonary oedema, renal failure, aortic dissection

Question 28

What medication can be give in a hypertensive emergency and what’s its mechanism of action?

Answer 28

Sodium nitroprusside - potent vasodilator of SM