Hypertension

Question 1

What is blood pressure?

Answer 1

It is the pressure of the blood exerted on the blood vessel walls

Question 2

What is the name of the arterial sound which can be heard when measuring blood pressure indirectly?

Answer 2

Korotkoff sounds.

Question 3

What is the definition of systolic and diastolic blood pressure?

Answer 3

Systolic: force of blood during contraction of the heart
Diastolic: relaxation of the heart, heart filling with blood in between beats

Question 4

How do you find pulse using the systolic & diastolic pressure?

Answer 4

Difference between systolic & diastolic = pulse

Question 5

What does BP = CO x TPR stand for?

Answer 5

Blood pressure = cardiac output x total peripheral resistance

Question 6

What is the cut off reading for someone to be hypertensive?

Answer 6

> 140/90 mmHg

OR 150/90 mmHg if >80yrs

Question 7

Why is hypertension known as a ‘silent killer’?

Answer 7

Because it is an asymptomatic condition, & symptoms only show when there is organ damage.

Question 8

Volume & viscosity of the blood is an example of a determinant of blood pressure. What are some other determinants?

Answer 8

1. Contraction of ventricles
2. Resistance of arterial blood vessels
3. Elasticity of arterial walls

Question 9

What is the difference between Ambulatory BP Monitoring (ABPM), vs. Home BP Monitoring (HBPM)?

Answer 9

ABPM: measures BP for 24h on the arm using a small device.
HBPM: self-monitoring at home

Question 10

How many stages are there for hypertension and what does this determine?

Answer 10

There are 3 stages. These stages determine which treatment the patient will receive.

Question 11

What is white coat hypertension?

Answer 11

When a patients BP is only high when a health care professional is taking a reading.

Question 12

What is pre-eclampsia?

Answer 12

It is high BP during a gestational (pregnancy) period.

Question 13

What is the most severe form of hypertension?

Answer 13

Accelerated hypertension.

Question 14

What are some examples of some conditions that hypertension is a major risk factor for?

Answer 14

1. Stroke
2. Myocardial infarction
3. Heart failure
4. Kidney disease
5. Premature death

Question 15

What is used to calculate a persons risk of developing a CV event within the next 10 years?

Answer 15

QRISK-3 calculator

Question 16

What things should patients avoid while managing their hypertension?

Answer 16

1. Alcohol
2. Coffee/caffeine rich products
3. Sodium intake
4. Smoking
5. Stress

Question 17

What is the benefit of inhibiting the RAAS system?

Answer 17

It reduces peripheral vascular resistance & blood vol.

Question 18

What do calcium channel blockers (CCB’s) do?

Answer 18

They inhibit Ca2+ influx into the myocytes, which is important in muscle contraction. This causes vasodilation & reduces heart rate.

Question 19

What are some examples of CCBs?

Answer 19

Amlodipine, nifedipine

Question 20

How do diuretics work?

Answer 20

They block Na+ reabsorption into the kidneys, so water follows & reduces blood vol.

Question 21

How do b-blockers work?

Answer 21

They reduce the workload of the heart & vessels, resulting in a lower cardiac output and slower heart beats.

Question 22

How do adrenergic inhibitors work?

Answer 22

They relax vascular smooth muscle which decreases peripheral resistance on the heart.

Question 23

How do ACEi work?

Answer 23

ACEi: angiotensin-converting enzyme inhibitor
They block angiotensin II production, relaxing blood vessels & reducing BP.
They also decrease aldosterone secretion to decrease Na+/H2O retention.

Question 24

How do angiotensin receptor blockers (ARBs) work?

Answer 24

They block aldosterone secretion and angiotensin II receptors.
This induces vasodilation which lowers BP & decreases Na+/H2O retention

Question 25

What drug is never given with ARBs?

Answer 25

ACEi

Question 26

What are some side effects associated with ACEi?

Answer 26

Headaches, dizziness, and a persistent dry cough.

Question 27

What are some examples of ACEi?

Answer 27

Perindopril, ramipril (they all end in -PRIL)

Question 28

What is the difference between non-dihydropyridines and dihydropyridines?

Answer 28

Dihydropyridines: they block Ca2+ channels in the blood vessels causing vasodilation
Non-dihydropyridines: they block Ca2+ channels in the heart causing a decreased heart rate

Question 29

What is an example of a non-dihydropyridine?

Answer 29

Verapamil.

Question 30

What are the 3 main types of diuretics?

Answer 30

1. Loop diuretics
2. K+ sparing
3. Thiazides

Question 31

Which type of beta receptor is found in the heart?

Answer 31

Beta-1 receptors.

Question 32

What are some examples of b-blockers used?

Answer 32

Atenolol, bisoprolol, metoprolol (ending in -OLOL)

Question 33

What system do alpha blockers work on, and what does this induce?

Answer 33

They work on the sympathetic nervous system, this induces vasodilation & a reduction in BP.

Question 34

What is the ACD rule (used for <55years & non-black?)

Answer 34

A - ACEi or ARBs
C - CCBs
D - Diuretics

Question 35

What are the steps of hypertensive treatment for >55yrs, or/& of black origin?

Answer 35

1. CCB (1 drug)
2. CCB + ARB or ACEi or thiazide (2 drugs)
3. CCB + ACEi or ARB + thiazide (3 drugs)

Question 36

What are some strategies which can improve drug adherence?

Answer 36

1. Simplify drug regimen
2. Start with small doses to lower risk of side effects
3. Label prescriptions clearly
4. Encourage calendars