Blood Pressure

Question 1

Define hypertension

Answer 1

Blood pressure above 140/90

Question 2

When should hypertension be treated?

Answer 2

If above 160/100 or above 140/90 with significant risk of coronary events, presence of diabetes or end-organ damage

Question 3

What is essential hypertension?

Answer 3

Hypertension with no identified cause - this accounts for 95% of cases

Question 4

What can cause secondary hypertension?

Answer 4

Renal - glomerulonephritis, chronic pyelonephritis
Endocrine - hyperaldosteronism, cushing’s, acromegaly
Drugs- glucocorticoid, NSAIDs, COOC
Other - pregnancy, coarctation of the aorta

Question 5

If a patient has been newly diagnosed with hypertension what other investigations should be done and why?

Answer 5

Urine dipstick - check for renal disease
ECG - check for left ventricular hypertrophy or IHD
Bloods - U&E (renal disease), HbA1c (diabetes), lipids (hyperlipidemia)
Fundoscopy - check for hypertensive retinopathy

Question 6

What are the 4 main classes of drug used to treat hypertension?

Answer 6

• ACE inhibitors - FIRST LINE <55 yo
• Calcium channel blockers - FIRST LINE > 55yo
• Angiotensin II receptor blockers
• Thiazide type diuretics

Question 7

How do ACE inhibitors work and name some examples?

Answer 7

Inhibit conversion of angiotensin I to angiotensin II eg. lisinopril, ramipril, enalapril

Question 8

How do calcium channel blockers work and name some examples?

Answer 8

Block voltage gated calcium channels, relaxing vascular smooth muscle and force of myocardial contracting e.g. amlodipine, nifedipine

Question 9

How do thiazide type diuretics work and name some examples?

Answer 9

Inhibit sodium absorption at the beginning of the distal convoluted tubule e.g. metolazone, chlorothiazide

Question 10

How do A2RBs work and name some examples?

Answer 10

Block effects of angiotensin II at its receptor eg. losartan

NB - these are usually used if a patient can’t tolerate ACEis due to side effects

Question 11

What are the side effects of ACE inhibitors?

Answer 11

Dry cough, angiodema, hyperkalemia

Question 12

What are the side effects of calcium channel blockers?

Answer 12

Flushing, ankle swelling, headache

Question 13

What are the side effects of thiazide type diuretics?

Answer 13

Hyponatremia, hypokalaemia, dehydration

Question 14

What are the side effects of A2RBs?

Answer 14

Hyperkalaemia

Question 15

When are ACEis contraindicated?

Answer 15

Afro-carribeans (less effective)
Pregnancy
Renal failure

Question 16

How do NICE guidelines advise these to be used?

Answer 16

Stepwise approach - keep adding until effective control is reached