Heart Failure & hypertension

Question 1

Describe the British Hypertension Society Grades of Hypertension & how these relate to thresholds for treatment

Answer 1

Grade 1 (mild): 140-159/90-99
normally non-pharmacological therapy (lifestyle therapy)

Grade 2 (moderate): 160-179/100-109
pharmacological therapy

Grade 3 (severe): >180/110
pharmacological therapy

Question 2

how is the threshold for pharmacological treatment different in diabetes

Answer 2

threshold is 140/90

target level is

Question 3

describe what is included in lifestyle therapy treatment for hypertension

Answer 3

patient education
normal body weight
reduce salt intake
reduce total & saturated fat
limit alcohol
regular aerobic activity
(smoking cessation reduces CV risk not BP)

Question 4

outline the treatment steps in non-black patients younger than 55yrs

Answer 4

ACE inhibitors
+ Calcium channel blocker
+ Diuretic (thiazide)
+ alpha blockers/ beta blockers/ vasodilators

move along stages if blood pressure not improved

Question 5

outline the treatment steps for patients older than 55 years or black

Answer 5

Calcium channel blocker
+ ACE inhibitors
+ Diuretic (thiazide)
+ alpha blockers/ beta blockers/ vasodilators

move along stages if blood pressure not improved

(reduced RAAS)

Question 6

ACE inhibitors:
examples
method of action
ADRs

Answer 6

e.g. Ramipril, Lisonopril

Inhibit ACE activity and generation of Ang II: reduces effect of RAAS
reducing production of aldosterone
potentiates action of Bradykinin

ADRs: dry cough, 1st dose hypotension renal failure, hyperkalaemia
(switch to ANG-II receptor blocker)

Question 7

Calcium channel blockers:
method of action
3 main groups - examples and ADRs

Answer 7

vasodilate peripheral, coronary & pulmonary arteries

Dihydropyridines (e.g. Amlodipine)
SNS activation (tachy, palpitations, flushing, sweating), ankle oedema, gynaecomastia

Phenylalkalamines (e.g. Verapamil)
constipation, bradycardia (dont give with beta blocker), negative ionotrophy

Benzothiazipines (e.g. diltiazem)
bradycardia, negative ionotrophy)

Question 8

Thiazide diuretics:
example
method of action
ADRs

Answer 8

e.g. Bendroflumethiazide

act on Na/Cl symporter in DCT
reducing distal tubular reabsorption
and reduced water reabsoprtion
causing reduce blood volume and TPR

ADRs: hypokalaemia, increased urea & uric acid (can cause gout), impaired glucose tolerance, increased cholesterol & triglycerides

uptitrating leels will only cause increase in risk of ADRs, not an increased response

Question 9

outline the treatment for heart failure

Answer 9

Antagonise RAAS: ACEi, aldosterone antagonist (e.g. spironolactonone)

Beta blocker

Question 10

define hypertension

Answer 10

> 140/90 mmHg