Hypertension

Question 1

Hypertension

Answer 1

= Hypertension is a RISK FACTOR not a disease

may lead to

• Stroke
• HF
• myocardial infarction
• renal failure

Question 2

Target of blood pressure ?

Answer 2

Arterial BP is systolic / Diastolic

Younger than 65 = 140/90

65 and older = 150/80

Question 3

What are the two types of hypertension?

Answer 3

1. Primary Hypertension - has no single cause (
2. Secondary Hypertension - cause can be identified
   - phaeochromcytoma (adrenal tumour)
   - primary aldosterone sam
   - renal disease
   - some meds (NSAIDS, oral contraceptives)

Question 4

Reason for treatment of BP?

Answer 4

= aims at lowering BP and reducing CV risk

Question 5

What are the non-pharmacological treatments for hypertension?

Answer 5

• regular physical activity
• weight reduction
• moderate sodium restriction
• healthy eating plan
• obstructive sleep apnoe management
• smoking cessation

Question 6

What are the pharmacological treatments for hypertension?

Answer 6

• thiazide diuretics
• Angiotensin Converting enzyme (ACE inhibitors)
• Angiotensin II receptor antagonists (spartans)
• Calcium channel blockers
• Beta adrenoreceptor antagonists (beta blockers)

Question 7

Choosing a anti hypertensive drug?

Answer 7

Start with mono therapy with

• ACE inhibitors
• startans
• CCB
• Thiazide diuretics (not in young pts )

NOTE: Beta blockers are not first line treatment

Question 8

What is the MOA for reducing BP through Thiazide diuretics?

Answer 8

= inhibit reabsorption of sodium and chloride in the early distal convoluted tubule of the nephron

• water and sodium loss and a reduction in the blood volume –> diuretic effect and early reduction in BP
• Produce vasodilation and reduce peripheral resistance over time –> longer term BP reduction

e.g. hydrochlorothiazide

Question 9

Drug interactions of Thiazide diuretics

Answer 9

• other RAAS acting drugs
• potassium sparing diuretics
• corticosteroids: may cause hypokalaemia

Question 10

What is the MOA for reducing BP through ACE inhibitors

Answer 10

= block conversion of angiotensin I to angiotensin II

• relax the arteries to lower BP

Question 11

What is the MOA for reducing BP through Calcium Channel blockers?

Answer 11

= lower BP by preventing calcium from entering cells of heat and arteries
- muscles cant contract without calcium

e.g Amlodipine

Question 12

What are the interactions with Calcium channel blockers?

Answer 12

• Diltiazem - reduce the elimination and increase the blood levels

Question 13

What is the MOA for reducing BP through Beta blocke4rs?

Answer 13

= completely block receptors in the heart

• decrease in HR, BP and cardiac contractability
• not first choice for BP as reduce renin release, reduce cardiac output and reduction in peripheral resistance

Question 14

Adverse reactions of Thiazide Diuretics?

Answer 14

• Dizziness
• orthostatic hypotension
• rash
• frequency and urgency urination increased
• electrolyte imbalance e.g. hypokalaemia

Question 15

Contradictions of thiazide diuretics?

Answer 15

• renal failure
• diuretic induced hypokalaemia
• anuria

Question 16

Nursing practice points for thiazide diuretics?

Answer 16

• Heart failure - may be given with loop diuretics to relieve symptoms of fluid retention
• monitor renal function, electrolytes, BP

Question 17

Adverse reaction of calcium channel blockers?

Answer 17

• Nausea
• vasodilatory effects
• peripheral oedema