Cardiovascular disease risk

Question 1

What is hypertension a risk factor for?

Answer 1

MI

Stroke

HF

CKD

Vascular dementia

Question 2

How is hypertension diagnosed?

Answer 2

Clinic BP >140/90

Repeat, take lowest

If high, 24-hour ABPM average >135/85

Use standing BP in elderly

Use highest arm

Question 3

What are the cutoffs for different stages of hypertension?

Answer 3

Stage I: >140/90

Stage 2: >160/100

Stage 3: >180/110

Question 4

Conversion between home and clinic BP measurements?

Answer 4

Clinic BP is 5/5 higher than home BP

Question 5

What inter-arm difference in BP is considered an independent risk factor for HTN?

Answer 5

>15 - use highest arm

Question 6

What did the HYVET trial show?

Answer 6

SBP <150 is associated with 34% RRR in patients >80

Earlier treatment is better

Should contron HTN in elderly

Question 7

Taking LSBPs

Answer 7

Repeat at 1 and 3 min after standing

Target standing BP

Question 8

BP targets for control

Answer 8

<80: <140/90

>80: <150/90

(Clinic readings)

Question 9

When should you initiate pharmacological treatment of BP?

Answer 9

Stage II or above

Stage I with:

• End-organ damage
• QRISK 3 >10%
• CKD
• Diabetes

If <40 - consider 2ry causes

If >80 - caution starting

Question 10

First line antihypertensive in type 2 diabetics

Answer 10

ACEi or ARB

Question 11

First line antihypertensive in age <55 and not Afro-Caribbean

Answer 11

ACEi or ARB

Question 12

First line anti-HTN in age >55 or Afro-Caribbean

Answer 12

Calcium channel blocker

Question 13

2nd line anti-HTN

Answer 13

Thiazide-like diuretic

e.g. indapamide, xipamide, chlortalidone, bendroflumethiazide

Question 14

side effects of CCBs

Answer 14

Cranium: Dizziness, drowsiness

Cardiac: Tachycardia, peripheral oedema, palpitations

Bowels: N+V, abdo pain

Skin: Flushing, rash

Spells CCBs!

Question 15

Side effects of thiazides

Answer 15

Renal: electrolyte disturbance, hypochloraemic alkalosis

leading to

Dizziness

Also

Urticaria

Constipation, diarrhoea

Question 16

Side effects of ACEi

Answer 16

Alopecia, skin reactions, angioedema

Cough, dry mouth, breathlessness

Ear (tinnitus), vertigo, headache, paresthesia

Question 17

Monitoring end-organ damage in HTN

Answer 17

Urine dip - proteinuria

Fundoscopy - retinopathy

Ulceration

Question 18

QRISK 3 cardiovascular risk factors

Answer 18

Smoking

Diabetes

HTN

Age

FHx (<60)

Erectile dysfunction

Hyperlipidaemia

Migraine

Chronic inflammatory condition

Erectile dysfunction

Severe mental illness

Atypical antipsychotic

Steroids

Question 19

Lifestyle recommendations for hypertension

Answer 19

Stop smoking

Reduce alcohol

Avoid excessive caffeine

Weight loss

Increase exercise

Reduce dietary Na, increase K+

Question 20

Bloods for initiating statin treatment

Answer 20

CK

Blood glucose, HbA1c

Lipid profile

Renal and liver function

Monitor at 3 and 12 months

Question 21

When to initiate statin treatment?

Answer 21

QRISK >10%

CKD

FHH

T1DM and >40, nephropathy, >10y diabetic

Question 22

Statin dose for primary prevention

Answer 22

atorvastatin 20mg OD

Plaque-stabilising effect indep of cholesterol lowering

Question 23

Statin dose for secondary prevention

Answer 23

80mg OD

Question 24

Cholesterol range indicating FHH

Answer 24

>7.5

Question 25

Side effects of ARBs

Answer 25

Abdo pain

Cough

GI disturbance

Vertigo

Electrolytes

Question 26

Follow-up with hypertension

Answer 26

Annual review, 6-monthly BP readings

Check renal f(x) annually

Question 27

Normal cholesterol levels

Answer 27

TC <5mmol/L

HDL >1

LDL <3

TC/HDL ratio <4.5