Hypertension

Question 1

Readings to be classed as stage 1 hypertension?

Answer 1

clinic - 140/90
home/ambulatory - 135/85

Question 2

Readings to be classed as stage 2 hypertension?

Answer 2

clinic - 160/100
home - 150/95

Question 3

Readings to be classed as stage 3 hypertension?

Answer 3

clinic systolic >180 or diastolic >120

Question 4

Step 1 treatment option for under 55s?

Answer 4

ACEi or ARB
ramipril 2.5mg or losartan 50mg OD

Question 5

step 1 treatment for over 55s or black African/ Afro-Caribbean?

Answer 5

Calcium channel blocker (amlodipine) 5mg OD
if ccb not tolerated offer thiazide-like diuretic (indapamide) 1.25mg OD

Question 6

Step 2 treatment?

Answer 6

ACEi/ARB AND CCB
if ccb not tolerated - thiazide-like diuretic

Question 7

preference for step 2 treatment for black african or afro-caribbean?

Answer 7

CCB and ARB

Question 8

Step 3 treatment?

Answer 8

ensure doses and adherence are optimal
ACEi/ARB AND CBB AND thiazide-like diuretic

Question 9

step 4 treatment?

Answer 9

• BP above 140/90 after step 3 = resistant htn
• offer additional low dose K sparing diuretic (spironolactone)
• alpha blockers (osin)
• beta blockers (lol)

Question 10

what needs to be monitored if offering additional diuretics?

Answer 10

monitor blood sodium, potassium and renal function within 1 month of starting treatment

Question 11

things to note when starting ACEi?

Answer 11

start low and go slow
postural hypotension and dry cough so take at night to begin
angioedema - especially in black pts

Question 12

advice for taking ccbs?

Answer 12

avoid grapefruit juice
caution in heart failure
long acting dihydropyridines for htn (-pine)

Question 13

advice for taking thiazide-like diuretics?

Answer 13

early morning dose
ceiling effect - higher dose has more side effects with little additional benefit