Hypertension 2: Management

Question 1

What are some lifestyle interventions that can help with hypertension?

Answer 1

• Diet (reduce salt and caffeine intake), weight reduction, exercise
• Alcohol consumption
• Smoking

Question 2

What information and resources would you give the patient?

Answer 2

• drug benefits and side effects
• details of patient organisations
• annual review of care

Question 3

What are some stats relating to lifestyle intervention and BP reduction?

Answer 3

Weight loss- 1mmHg lower for every kg
aerobic exercise- 15min/day= 14% reduced mortality.
No salt added diet- BP reduces 2-4mmHg

Question 4

What are the common drug types used in hypertension? give an example for each.

Answer 4

• ACEI/ARB: Lisinopril/Losartan
• Ca blocker: Amlodipine/ Verapamil
• thiazide diuretics: Bendroflumethiazide
• B blockers: Propanalol
• Spironolactone/ Alpha blockers.

Question 5

What are the steps of drugs used for hypertension?

Answer 5

acronym: ACD
Step 1- ACE/ARB or CCB (only if black or over 55)
Step 2- ACE/ARB + CCB
Step 3- ACE/ARB + CCB + Thiazide like Diuretic
Step 4 - All of above + Spironolactone or Alpha or B blocker.

Question 6

Is adding or titrating a drug more effective for treatment?

Answer 6

Adding a drug to the treatment. (Eg 3 drugs instead of one)

Question 7

Why is combination therapy better than mono-therapy?

Answer 7

Better effects. Fewer side effects

Question 8

What are some common causes of resistant hypertension?

Answer 8

1. Non concordance
2. White coat effect
3. 2ndary hypertension

Question 9

What is the most effective treatment for resistant hypertension?

Answer 9

Spironolactone.

Question 10

What are some new surgical interventions that help in Hypertension?

Answer 10

1. Percutaneous renal denervation- catheter tip inserted in distal renal artery.
2. Carotid bart-receptor stimulation.