Cardiovascular drugs 2

Question 1

Hypertension

Answer 1

Clinic BP > 140/90 +

ABPM/HBPM > 135/85

Question 2

Next steps if clinic BP > 140/90

Answer 2

• Take a second measurement during the consultation
• If the second measurement is substantially different from the first, take a third measurement
• Record the lower of the last 2 measurements as the clinic blood pressure

Question 3

Activities that can affect BP reading

Answer 3

Cuff too small 
Cuff over clothing 
Back/feet unsupported 
Legs crossed not resting(3-5 mins) 
Patient talking 
Pain

Question 4

ABPM

Answer 4

If clinic blood pressure is between 140/90mmHg and 180/120mmHg, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension

If ABPM is unsuitable or the person is unable to tolerate it, offer home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension

Question 5

HBPM

Answer 5

• Two consecutive seated measurements, at least 1 minute apart

–blood pressure is recorded twice a day for at least 4 days and preferably for a week

–measurements on the first day are discarded – average value of all remaining is used.

Question 6

ABPM/HBPM + clinic BP outcomes

Answer 6

Normotensive by both methods (true normotension)

Hypertensive by both methods (true hypertension)

Hypertensive based on office BP and normotensive by ABP/HBPM (white-coat hypertension)

Question 7

Causes of secondary hypertension

Answer 7

Primary(essential) > 90%
Secondary < 10%

Renal disease - renovascular disease, renal parenchymal disease

Endocrine disease - Conn’s, cushing’s, phaeochromocytoma

Drugs - COC pills, steroids, nsaids, cocaine, epo

Vascular

Other - obstructive sleep apnoea, pregnancy included

Question 8

Contributory factors to hypertension

Answer 8

• Increase in BMI
• > 14 units of alcohol
• Salt intake
• Lack of exercise
• Stress
• Caffeine

Question 9

Cardiac output

Answer 9

HR x SV

Question 10

BP formula

Answer 10

CO x SVR(systemic vascular resistance)

Question 11

Hypertension symptoms

Answer 11

• Headache
• Blurred vision
• Dizziness
• SOB
• Palpitations
• Epistaxis

Question 12

Hypertension - examination

Answer 12

• Cardiovascular system
• Abdomen
• Fundoscopy