Cardiovascular drugs 2

Question 1

How common is hypertension in England?

Answer 1

Affects 1 in 4 adults

Affects 60% of those over 75

Question 2

What are the benefits of a 10mmHg reduction in BP?

Answer 2

17% decrease in coronary heart disease
27% reduction in stroke
28% reduction of heart failure
13% of all cause mortality

Question 3

What is the diagnosis of hypertension?

Answer 3

Clinic BP above 140/90

ABPM / HBP above 135/85

Question 4

Describe how HBPM is done

Answer 4

2 consecutive seated measurements at least 1 minute apart
BP recorded twice a day for at least 4 days
Measurements of 1st day are discarded and average values of the remaining days are used

Question 5

What activities can increase BP reading?

Answer 5

Cuff too small
Cuff over clothing
Back / feet unsupported
Legs crossed
Not resting
Patient talking
Pain

Question 6

What is true normotension?

Answer 6

Normotensive by ABPM / HBPM and clinic BP

Question 7

What is true hypertension?

Answer 7

Hypertensive results from ABPM / HBPM and clinic BP

Question 8

What is the diagnosis of white coat hypertension?

Answer 8

Hypertensive based on clinic BP and normotensive based on ABPM / HBPM

Question 9

What is the diagnosis of masked hypertension?

Answer 9

Normotensive by clinic BP and hypertensive by ABPM / HBPM

Question 10

What are the secondary causes of hypertension?

Answer 10

Renal disease - renovascular disease, renal parenchyma disease
Endocrine disease - Conn’s, Cushing’s, phaemochromocytoma
Drugs - COCP, steroids, NSAIDs, cocaine, EPO
Vascular
Obstructive sleep apnoea
Pregnancy

Question 11

What are some contributory factors that can cause hypertension?

Answer 11

Increased BMI
>14 units of alcohol
Salt intake
Lack of exercise
Stress

Question 12

What are the risk factors for hypertension?

Answer 12

Male
Age
Family history and ethnicity
Smoker
Cholesterol
Diabetes

Question 13

What is the equation for blood pressure?

Answer 13

Cardiac output X systemic vascular resistance

Question 14

What is the equation for cardiac output?

Answer 14

Heart rate X stroke volume

Question 15

What are the symptoms of hypertension?

Answer 15

None
Headache
Blurred vision
Dizziness
Shortness of breath
Palpitations
Epistaxis

Question 16

What investigations should be done for hypertension?

Answer 16

Urinalysis - proteinuria and haematuria
ECG - LVH, AF
Blood tests -U and E, LFT, lipids, glucose, HbA1c

Question 17

What are some non-pharmacological recommendations for hypertension treatment?

Answer 17

Weight reduction
DASH eating plan
Dietary sodium restriction
Physical activity
Alcohol moderation

Question 18

What is the first drug class that should be given for hypertension with type 2 diabetes?

Answer 18

ACEi or ARB

Question 19

What is the first drug class that should be given for hypertension under 55?

Answer 19

ACEi or ARB

Question 20

What is the first drug class that should be given for hypertension over 55 or black-afro Caribbean origin?

Answer 20

CCB

Question 21

What drugs can be given for resistant hypertension?

Answer 21

Low dose spironolactone

Alpha blocker or beta blocker

Question 22

What are the BP treatment targets for those under 80 years old?

Answer 22

Clinic BP below 140/90mmHg

ABPM / HBPM below 135/85

Question 23

What are the BP treatment targets for those over 80 years old?

Answer 23

Clinic BP below 150/90mmHg

ABPM / HBPM below 145/85

Question 24

What should you check before starting ACEi or ARB?

Answer 24

Serum creatinine and potassium

Question 25

When are ACEi / ARBs contraindicated?

Answer 25

Pregnancy | Breastfeeding

Question 26

What is the white coat effect?

Answer 26

Discrepancy of over 20/10mmHg between clinic and average daytime ABPM / HBPM at time of diagnosis

Question 27

What are the causes of treatment failure?

Answer 27

Pseudo-resistant hypertension Secondary hypertension Resistant hypertension

Question 28

What is a hypertensive emergency?

Answer 28

Severe hypertension with acute damage to target organs | BP above 180/110mmHg

Question 29

What is the treatment for a hypertensive emergency?

Answer 29

Same day specialist review IV therapy - labetalol, GTN, sodium nitroprusside, esmolol Reduce BP / MAP 20-25% in 1-2 hours Target of 160/100 in 6 hours

Question 30

What is a hypertensive urgency?

Answer 30

Severe hypertension without acute damage to target organs | Reduce BP in 1-2 days

Question 31

What is the treatment for hypertensive urgency?

Answer 31

ABPM / HBPM Oral treatment GP review in 48 hours

Question 32

What are the clinical features of a hypertensive crisis?

Answer 32

``` Asymptomatic Headache Epistaxis Presyncope Palpitations Chest pain Dyspnoea Neurological deficit ```

Question 33

What is the pathophysiology of a hypertensive crisis?

Answer 33

Dysfunction of renin-angiotensin-aldosterone system Acute baroflex failure Autodysregulation

Question 34

What are the secondary causes of a hypertensive crisis?

Answer 34

``` Intracranial haemorrhage / SOL Phaeochromocytoma Drugs Pre-eclampsia / eclampsia Renal artery stenosis Carotid baroreceptor dysfunction ```

Question 35

When should statins be offered for the prevention of CVD?

Answer 35

If greater than 10% 10-year risk of developing CVD Type 1 diabetes Chronic kidney disease Those over 85 years

Question 36

What blood tests should be done before starting statins?

Answer 36

``` Lipid measurement Liver function tests Renal function HbA1c Thyroid stimulating hormone Creatine kinase ```

Question 37

What follow up should be done after starting statins?

Answer 37

Lipid measurement Liver function tests Creatine kinase if symptomatic Medication reviews

Question 38

When should ezetimibe be considered?

Answer 38

Recommended to treat primary hypercholesterolaemia in adults in whom initial statin therapy is contraindicated or not tolerated