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STG 2017 > HYPERTENSION > Flashcards

HYPERTENSION Flashcards

1
Q

When is BP treatment initiated in the general adult population

A

140/90 or higher

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2
Q

When is BP treatment initiated in people over 60 years of age

A

150/90 or higher

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3
Q

Risk factors for primary hypertension

A

Age
Family history
Obesity
Sedentary lifestyle

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4
Q

When should BP treatment be initiated for patients with CKD or diabetes

A

140/90 or higher

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5
Q

Cardiovascular risk factors

A

Age (men ≥ 55 years; women ≥ 65)
Family history of premature cardiovascular disease (men aged < 55 years;
women aged < 65)
Dyslipidaemia
Obesity (BMI ≥ 30 kg/m2)
Diabetes mellitus
Smoking
Pulse pressure (in the elderly) ≥ 60mmHg
Microalbuminuria or proteinuria
Left ventricular hypertrophy
Left bundle branch block
Ischaemic heart disease
Previous stroke or TIA
Periperal arterial disease
Heart failure
Coronary artery disease
Chronic kidney disease
Advanced retinopathy:

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6
Q

Signs of advanced retinopathy

A

haemorrhages or exudates, papilloedema

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7
Q

Renal causes of secondary hypertension in adults

A

CKD
Polycystic kidney disease

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8
Q

Endocrine causes of hypertension in CKD

A

Phaeochromocytoma
Cushing’s syndrome
Conn’s disease
Hypothyroidism
Hyperthyroidism
Acromegaly

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9
Q

Investigations in hypertension

A

FBC
Chest X-ray
ECG
Urinalysis
BUE/Cr
Serum lipids
Blood glucose
Serum uric acid
Renal and adrenal ultrasound
Echocardiogram

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10
Q

Treatment objectives for hypertension in adults

A

To reduce blood pressure levels to recommended targets:
To manage co-morbid conditions
To prevent cardiovascular, cerebrovascular and renal complications
To promote therapeutic lifestyle changes
To identify and manage secondary hypertension appropriately

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11
Q

Recommended BP targets in adults

A

< 140/90 mmHg for age below 60 years, diabetes, CKD
< 150/90 mmHg for age above 60 years

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12
Q

Non-pharmacological interventions in hypertension

A

Reduce salt intake
Reduce animal fat intake
Ensure regular fruit and vegetable intake
Weight reduction in obese and overweight individuals
Regular exercise e.g. brisk walking for 30 minutes 3 times a week
Reduction in alcohol consumption
Avoid or quit smoking

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13
Q

First line drugs in hypertension

A

Thiazide Diuretics
Calcium Channel Blockers
Angiotensin Converting Enzyme Inhibitors
Angiotensin Receptor Blockers
Beta-blockers

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14
Q

Preferrable antihypertensive drugs in blacks

A

thiazide diuretics or calcium channel blockers, either as monotherapy or in some combination therapy

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15
Q

According to STG angiotensin converting enzyme Inhibitors are not recommended as first-line drugs for
uncomplicated hypertension in black patients. T/F

A

True

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16
Q

When should dual therapy be started

A

Dual therapy should be started earlier when the blood pressure exceeds
180/110 mmHg.

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17
Q

Preferred antihypertensives in left ventricular hypertrophy

A

ACEi/ARB
CCB, preferably amlodipine

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18
Q

Preferred antihypertensives in renal dysfunction

A

ACE-I or ARB; Caution- if eGFR <15min/ml without renal
replacement therapy

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19
Q

Preferred antihypertensive medications in microalbuminuria

A

ACEi or ARB

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20
Q

Preferred antihypertensive medications in previous stroke

A

Any of the first-line drugs, especially ACE-I

21
Q

Preferred antihypertensive medications in coronary artery disease

A

ACE-I or ARB
Beta-blocker
CCB

22
Q

Preferred antihypertensive medications in heart failure

A

ACE-I or ARB
Cardio-selective B-Blockers- bisoprolol, metoprolol, carvedilol
Loop diuretics
Spironolactone in advanced heart failure

23
Q

Preferred antihypertensive medications in PAD

A

CCB
ACEi/ARB

24
Q

Preferred antihypertensive medications in diabetics

A

ACEi/ARB

25
Q

Preferred antihypertensive medications in atrial fibrillation

A

ARB/ACEi
Beta blockers

26
Q

Contraindications to thiazides

A

Gout

27
Q

Contraindications to beta blockers

A

Asthma
2nd and 3rd Degree AV block

28
Q

Contraindications to CCB

A

Heart failure

29
Q

Contraindications to ACEi and ARB

A

Bilateral renal artery stenosis
Hyperkalemia

30
Q

Dose of bendroflumathiazide in hypertension

A

2.5mg daily

31
Q

Dose of hydrochlorothiazide in hypertension

A

12.5 to 25mg daily

32
Q

Dose of amlodipine in hypertension

A

5 to 10mg daily

33
Q

Dose of nifedipine retard in hypertension

A

10 to 40mg 12 hourly

34
Q

Dose of lisinopril in hypertension

A

10 to 40mg daily

35
Q

Dose of ramipril in hypertension

A

2.5 to 10mg daily

36
Q

Dose of losartan in hypertension

A

25 to 100mg daily

37
Q

Dose of candesartan in hypertension

A

4 to 32mg daily

38
Q

Dose of valsartan in hypertension

A

80 to 160mg daily

39
Q

Dose of atenolol in hypertension

A

50 to 100mg daily

40
Q

Dose of bisoprolol in hypertension

A

5 to 20mg daily

41
Q

Dose of metoprolol in hypertension

A

50 to 200mg 12 hourly

42
Q

Dose of carvedilol in hypertension

A

12.5 to 50mg daily

43
Q

Dose of labetalol in hypertension

A

100 to 400mg daily

44
Q

Second line agents in hypertension

A

Centrally acting agents - methyldopa
Vasodilators- hydralazine
Alpha blockers - prazosin
Aldosterone antagonists- spironolactone

45
Q

Dose of methyldopa in hypertension

A

250 to 1g 8 to 12 hourly

46
Q

Dose of hydralazine in hypertension

A

25 to 50mg daily

47
Q

Dose of prazosin in hypertension

A

0.5 mg 8-12 hourly and increasing gradually to a max. dose of 20 mg

48
Q

Dose of spironolactone in hypertension

A

Spironolactone, oral, 25-50 mg daily

49
Q

Referral criteria for hypertension

A
  1. Those not achieving the target blood pressure (BP) level after several months of treatment
  2. Those on three or more anti-hypertensive drugs, yet have poor BP control
  3. Those with worsening of BP over a few weeks or months
  4. Those with plasma creatinine levels above the upper limit of normal
  5. Those with diabetes mellitus
  6. Those with multiple risk factors (diabetes, dyslipidaemia, obesity, family history of heart disease)
  7. Those not on diuretics but have persistently low potassium on repeated blood tests
  8. All children, young adults and pregnant women with elevated BP

STG 2017 (88 decks)

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