HTN - Heart foundation Flashcards
Which BP should be used for the CVD calculator?
A. Home BPs
B. Ambulatory BPs
C. Clinic BPs
D. Halter monitor BPs
C - Clinic BPs
If a patient has low absolute CVD risk (<10% over 5 years), at which BP should an antihypertensive be started (if it is persistant)?
A. 140/90
B. 150/90
C. 160/100
D. 180/100
C - 160/100
If a patient has moderateabsolute CVD risk (10015% over 5 years), at which BP should an antihypertensive be started (if it is persistant)?
A. 140/90
B. 150/90
C. 160/100
D. 180/100
A - 140/90
Which class of anti-hypertensives is NOT first line in uncomplictaed HTN?
A. ACE
B. ARB
C. Ca2+ blocker
D. b-Blocker
D - B-blocker
For patients with a history of TIA or stroke antihypertensive treatment is recommended for:
A. 140/90
B. 150/90
C. 160/100
D. As tolerated
D - As tolerated
In patient with previous history of MI, which are first line anti-hypertensives?
A. ACE and ARB
B. ACE and B-blocker
C. ACE and Ca2+ blocker
D. ACE and thiazide diuretics
B - ACE and B-blocker
For patients with uncomplicated HTN which is NOT a first line anti-hypertensive?
A - ACEi/ARB
B- B-blocker
C- Calcium channel blocker
D - Thiazide diuretic
B- B-blocker
For patients with angina, which medications are first line?
A. B-blocker or Ca2+ blocker
B. B-blocker and ACE
C. ACE or B-blocker
D. ACE or Ca2+ blocker
A - B-blocker or Ca2+ blocker
Which b-blocker is not recommended in patients with heart failure?
A. Carvedilol
B. Atenolol
C. Bisoprolol
D. Nebivolol
B - Atenolol
Define a hypertensive urgency
A - BP >180/110, associated with symptoms (e.g. severe headache) or moderate end organ damage
B - Very high BP with acute target organ damage or dysfunction is present (heart failure, APO, MI, AA, neurology , encephalopathy, papilloedema, stroke)
C - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate
D - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate plus papilloedema
A - BP >180/110, associated with symptoms (e.g. severe headache) or moderate end organ damage
Define a hypertensive emergency
A - BP >180/110, associated with symptoms (e.g. severe headache) or moderate end organ damage
B - Very high BP with acute target organ damage or dysfunction is present (heart failure, APO, MI, AA, neurology , encephalopathy, papilloedema, stroke)
C - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate
D - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate plus papilloedema
B - Very high BP with acute target organ damage or dysfunction is present (heart failure, APO, MI, AA, neurology , encephalopathy, papilloedema, stroke)
Define accelerated hypertensive
A - BP >180/110, associated with symptoms (e.g. severe headache) or moderate end organ damage
B - Very high BP with acute target organ damage or dysfunction is present (heart failure, APO, MI, AA, neurology , encephalopathy, papilloedema, stroke)
C - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate
D - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate plus papilloedema
C - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate
Define malignant hypertension
A - BP >180/110, associated with symptoms (e.g. severe headache) or moderate end organ damage
B - Very high BP with acute target organ damage or dysfunction is present (heart failure, APO, MI, AA, neurology , encephalopathy, papilloedema, stroke)
C - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate
D - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate plus papilloedema
D - Severe HTN (BP >180/110) accompanied by retinal haemorrhage and exudate plus papilloedema
List the co-morbidities and demographics that would make the CVD risk calculator unsuitable to be used?
Indigenous Australians <35yo or >74yo
Other Australians <45yo
Persistently high BP >180/11
Previous CVD (angina, MI, stroke/TIA, PVD, AF)
Diabetes >60yo Diabetes with microalbuminuria
CKD ACR >25 M, > 35F, eGFR <45
Familial hypercholesterolaemia
Total cholesterol >7.5
How should HTN be diagnosed in a clinic setting
A - On at least two occasions, one or more weeks apart
B - From the average of three blood pressures 5 minutes apart on a single visit during a full cardiovascular risk assessment
C - By taking the BP from both arms and using the one with the lowest blood pressure
A - On at least two occasions, one or more weeks apart
Gold standard is suggested:
- patient should be alone in a quiet room for measurement
- cuff should be at heart level, supporting the arm
- cuff placed 2cm above elbow
- not cross-legged
- refrain from caffeine and smoking 2h prior to measurement
- measure both arms, esp if evidence of PVD - use the higher reading arm for subsequent BPs if >5mmHg (otherwise either is fine)
- to take 3 measurements averaging the last two - round no more than 2mmHg
List the initial laboratory investigation for all patients with newly diagnosed HTN
Urine dipstick for blood
Urine albuminuria and proteinuria
Fasting BSL
Fasting lipid profile
FBC UECs
12 lead ECG
What is the physical activity recommendation for patients with hypertension?
150-300 minutes moderate intensity activity
OR 75-150 miutes vigorous activity each week.
AND Muscle strenthening 2 days/week
How long after starting or changing an anti-hypertensive should you consider your current regieme “ineffective”
A - 2 weeks
B - 4 weeks
C - 6 weeks
D - 12 weeks
D - 12 weeks
* optimal dose response is often reached at 4-6 weeks and in those at high risk or with very high BP regiemes can be titrated faster if needed
If your inital low dose DUAL thearpy is “ineffective” the next step should be:
A - up titrate the each medication (excluding thiazide diuretcis) to the next available dose preperation one at a time
B- up titrate the both medications (excluding thiazide diuretcis) to the next available dose preperation each time
C - up titrate one drug (excluding thiazide diuretcis) incrementally to the maximal recommended dose before increaseing the dose of the other
D - add a third drug from a different class keeping each at the lowest possible dose
C - up titrate one drug (excluding thiazide diuretcis) incrementally to the maximal recommended dose before increaseing the dose of the other
If maximal doses of two drug classes has been reached a third drug class may be be added at a low-moderate dose
If your initial treatment with low-dose monotherapy is “ineffective” the next step should be:
A - up titrate the current medication to the next available dose preperation
B - cease the current therapy and change to a new medication
C - add a second drug from a different class
D - complete a trial of lifestyle changes before considering changing pharmacological therapy
C - add a second drug from a different class
This reduces the risk of adverse-effects while maimising efficacy
Lifestyle changes should be addressed at the start and generlly only alter BP by
Which of the following is NOT true of thiazide diuretics:
A - it is associated with increased risk of diabetes/worsening of current diabetes
B - it is associated with increased risk of postural hypotension and falls in the elderly
C - it is associated with increased risk of gout
D - it is associated with exacerabation of heart failure
D - it is associated with exacerabation of heart failure
25% increased risk of falls in the elderly
Thiazide diuretics can be useful in the presence of heart failure or post stroke
Which of the following is NOT true regarding ACEi:
A - They can cause an irritating cough
B - They can cause angioedema even years after initiation
C - They can impair renal function when used combination with NSAIDs
D - They are considered equal and interchangable with ARBs in all patients
D - They are considered equal to ARBs
ACEi are superior in:
- preventing nephropathy
- reducing morality in early diabetes
- preventing CAD in those with ARBs
ARBs are superior in :
- preventing renal railure in peioe with advanced diabetic nephropathy
Which of the following IS TRUE in relation to calcium channel blockers?
A - short acting preperations are prefered
B - calcium channel induced peripheral oedema can be managed by diuretics
C - postural hypotension is a common side effect
D - verapamil and diltiazam can be used in combination with b-blockers
C - postural hypotension is a common side effect
Which of the following is NOT true of B-blockers
A - B-blockers should alwasy be down-titrated over 2 weeks to avoid rebour hypertension and MI
B - Atenolol is a recommended first line B-blocker
C - They are contraindicated in patients with A-V heart block
D - They are associated with increased risk of diabetes
B - Atenolol is a recommended first line B-blocker
According to the SPRINT trial, in those patients with hypertension PLUS diabetes, CKD or high cardiovascular (including stroke) risk hypertension target BP is:
A - Systolic <120
B - <130/80
C - <140/80
D - <140/90
A - Systolic <120
According to the SPRINT trial, in patient with uncomplicated hypertension target BP is:
A - Systolic 120
B - <130/80
C - <140/80
D - <140/90
D - <140/90
Following the initiation of anti-hypertensive therapy patients should be reviewed at the minimal interval of:
A - 1-2 weeks
B - 2-4 weeks
C - 4-6 weeks
D - 6-12 weeks
C - 4-6 weeks
Electrolytes (K+) and Cr should be measured at this time for those at risk of changes in kidney function
True of False
For patients with a very high baseline BP (i.e. >20 mmHg systolic and >10mmHg diastolic) starting treatment with more than one drug class may be considered
True
True or False
If clinic BP is >140/90 ambulatory and/or home BP monitoring should be offered to confirm the BP levels
True
However, the clinic BPs should still be used for the CVD risk calculator as home and ambulatory BPs may understimate risk as they have not been validates for the calculator
What is the acceptable decline of eGFR after starting an ACEi/ARB in those with CKD?
25% within 2 months
If greater than this the ACEi/ARB should be stopped and referral to a nephrologist should be made
