Hypertension

Question 1

What is hypertension defined as?

Answer 1

A blood pressure of 140/90mmHg or higher.

Question 2

What can be done if white coat hypertension is suspected?

Answer 2

Use a home blood pressure monitoring device or an ambulatory blood pressure monitor.

Question 3

What is the order of treatment of hypertension for individuals who have type 2 diabetes or are under 55 and aren’t black:

Answer 3

1. ACE inhibitor (or ARB)
2. Add CCB or thiazide-like diuretic
3. ACE (or ARB) + CCB + thiazide-like diuretic.
4. Either add a 4th antihypertensive or low-dose spironolactone (if K+ 4.5mmol/L or less)

Question 4

What is the order of treatment of hypertension for individuals who don’t have type 2 diabetes and are over 55, or are black:

Answer 4

1. CCB
2. CCB + either ACE inhibitor (or ARB) or thiazide-like diuretic
3. ACE inhibitor (or ARB) + CCB + thiazide-like diuretic
4. Either add a 4th antihypertensive or low-dose spironolactone (if K+ 4.5mmol/L or less) or alpha or beta-blocker (if K+ levels inappropriate for spironolactone).

Question 5

Name 2 ACE inhibitors

Answer 5

Ramipril
Lisinopril

Question 6

How do ACE inhibitors work?

Answer 6

Inhibit angiotensin converting enzyme to prevent production of angiotensin II, thus preventing it from causing vasoconstriction.

Question 7

What are the side effects of ACE inhibitors?

Answer 7

Ramipril - cough
Postural hypotension
GI discomfort
Arrythmias

Question 8

What conditions are ACE inhibitors cautioned/contraindicated in?

Answer 8

Angioedema - angioedema
Diabetes - low glucose
Postural hypotension
Hepatic impairment
Renal impairment

Question 8

What monitoring is required for ACE inhibitors

Answer 8

Renal function and electrolytes baseline and continuous

Question 9

What are some common drug interactions of ACE inhibitors?

Answer 9

NSAIDs - nephrotoxicity and hyperkalaemia
Lithium - lithium toxicity

Question 10

Name 2 Angiotensin Receptor Blockers

Answer 10

Losartan
Candesartan

Question 11

How do ARBs work?

Answer 11

Blocks angiotensin II receptor to prevent activation leading to vasoconstriction

Question 12

What are some common side effects of ARBs?

Answer 12

GI discomfort
Postural hypotension
Back pain
Hypoglycaemia
Hyperkalaemia

Question 13

What are ARBs contraindicated in?

Answer 13

Heart failure

Question 14

What are some key interactions of ARBs?

Answer 14

Aliskiren - severe risk of renal impairment and hypoglycaemia (if diabetic)
Lithium - lithium toxicity

Question 15

Name 4 calcium channel blockers

Answer 15

Amlodipine
Diltiazem
Felodipine
Verapamil

Question 16

How do calcium channel blockers work?

Answer 16

Inhibit calcium influx into vascular smooth muscle and cardiac muscle to prevent contraction/encourage vasodilation.

Question 17

What are some common side effects of CCBs?

Answer 17

GI discomfort
Tachycardia
Peripheral oedema
Headache

Question 18

What conditions are calcium channel blockers contraindicated/cautioned in?

Answer 18

Unstable angina
Aortic stenosis
Cardiogenic shock

Question 19

How can a person’s cardiovascular risk be assessed?

Answer 19

Using QRISK3 score which indicates their risk of a cardio event in the next 10 years.

Question 20

What action should be taken if a person has a QRISK3 score of over 10%?

Answer 20

Require primary prevention - 20mg atorvastatin once a day.

Question 21

What is the short term aim of statins as primary prevention of cardiovascular events?

Answer 21

After 3 months, non-HDL cholesterol reduction should be at least 40%.

Question 22

When should statins be taken?

Answer 22

Ideally before bed as cholesterol production happens at night.
However, Atorvastatin is a long-acting statin so can technically be taken at any time.

Question 23

How do statins work?

Answer 23

Inhibit HMG-CoA reductase, the rate limiting enzyme in cholesterol synthesis.

Question 24

Can statins be taken during pregnancy?

Answer 24

No - can cause congenital abnormalities.

Question 25

Can aspirin be used for primary prevention of CVD events?

Answer 25

No - just for secondary prevention.