CVD - BLOOD PRESSURE

Question 1

What are the guidelines for HTN?

Answer 1

1) Under 55 - ACE. Over 55 - CCB
2) ACE + CCB
3) ACE + CCB + D

Question 2

Why should you avoid Thiazide like diuretic and beta blocker together?

Answer 2

Causes hyperglycaemia

Question 3

How many measurements of blood pressure need to be taken to confirm HTN (according to NICE)?

Answer 3

14 measurements

Question 4

What are the stages of HTN?

Answer 4

Normal - 120/80

Stage 1 - 140/90

Stage 2 - 160/100

Hypertensive crisis - systolic is over 180 and bottom one is over 110 - reduce BP slowly otherwise reduced organ perfusion

Question 5

In stage 1 you normally treat with lifestyle advice, what would be exceptions to this?

Answer 5

In patients under 80 who have organ damage, CVD, renal disease, DM, or 10 year CV risk - use actual treatment

Question 6

What is the BP target for patients under 80? (normal and with complications)

Answer 6

Normal - <140/90

Complications - <130/80

Question 7

What is the BP target for patients over 80?

Answer 7

<150/90

Question 8

What is the BP target for patients who have renal disease?

Answer 8

<140/90

Question 9

What is the BP target for pregnant women?

Answer 9

<150/90 chronic HTN

<140/90 chronic HTN and if target organ damage or given birth

Labetalol = 1st choice in gestational HTN (not in first trimester)

Question 10

Which ACE inhibitor needs to be taken 30-60 minutes before food?

Answer 10

Perindopril

Question 11

What are the side effects of ACE inhibitors?

Answer 11

Persistent dry cough - give ARB as alternative

Hyperkalaemia - higher risk in renally impaired and diabetic

Anaphylactoid reactions - angiodema, NSAIDs

Renal effects - CKD, Stop DAMN drugs in renal impairments (diuretics, ace, metformin, nsaids)

Hepatic effects - jaundice, hepatic failure

Hypoglycaemia

Question 12

What interacts with ACE inhibitors?

Answer 12

Drugs that induce hyperkalaemia - Aliskeren, ARB, Potassium sparing diuretics

Nephrotoxic drugs - NSAIDs

Diuretics

Question 13

What are some examples of centrally acting antihypertensives?

Answer 13

Methyldopa, Clonidine, Moxonidine

Question 14

What are the main side effects of beta blockers?

Answer 14

Bradycardia

Hypotension

Mask symptoms of hypoglycaemia

Question 15

In which patient groups are beta blockers contra-indicated?

Answer 15

Asthmatics - causes bronchospasm

Worsening/unstable heart failure

Second or third degree heart block

Severe hypotension or bradycardia

Question 16

In what patient group would thiazide-like-diuretics be ineffective?

Answer 16

Patients with renal failure