Case Study 4 Flashcards
In a routine medical examination, a 47 year old company director is found to have a blood pressure of 170-100. No other significant clinical abnormalities are found. What is the most likely diagnosis?
Primary hypertension
Give four essential investigations that should be done to confirm a diagnosis
- FBC
- U&Es
- blood glucose
- blood lipids
- urinalysis - protein
- CXR
- ECG
On confirmation of your diagnosis, give four classes of drugs that can be used for treatment and give an example of each
- Diuretics e.g. bendrofluazide
- Beta-blockers e.g. atenolol
- CCBs e.g. verapamil
- ACEI e.g. lisinopril
- Alpha blocker e.g. doxazosin
- Angiotensin II antagonists e.g. candesaran
What is the key management strategy for his condition?
- address all risk factors
- medical therapy tailored to the patient
Give six risk factors for his condition
- smoking
- excess alcohol intake
- obesity
- lack of exercise
- diabetes mellitus
- hyperlipidaemia
What is primary hypertension?
Hypertension with no underlying cause - complex multifactorial disorder which arises due to an interaction of genetic and environmental factors
What benefits will improving exercise participation have?
- lowers blood pressure
- improves prognosis in other related CVS disease
Give two important underlying risk factors for developing secondary hypertension?
- diabetes
- hyperlipidaemia
What effects do ACE inhibitors have when used in hypertensive diabetics?
- slow onset of microvascular complications
- have a slight positive effect on lipid profiles
What drug is particularly useful in resistant hypertension?
Doxazosin
What would indicate resistant hypertension?
When two or three agents in combination have failed to lower the blood pressure
Doxazosin is useful in what other patients?
Patients with associated hyperlipidaemia as it has beneficial effects on the lipid profile
What drug remains the first line treatment for primary hypertension?
Bendrofluazide
