Hypertension

Question 1

What is the difference between primary and secondary hypertension?

Answer 1

Primary HPT is commonly seen in the community and the cause is unknown
Secondary HPT is from underlying disorder like tumour in the adrenal medulladeep and primary aldosteronism (too much aldosterone)

Question 2

Which HBP drugs do not work well for the African origin?

Answer 2

ACEI and BB

Question 3

How is Low BP raised back up in normal pt?

Answer 3

Low BP triggers renin secretion, aldosterone secretion and then increases sodium reabsorption and potassium excretion to increase blood volume
Angiotensin 2 production causes vasoconstriction and raise blood pressure

Question 4

What is the BP range of high-normal??

Answer 4

120-139 / 80-89

Question 5

What is the range of isolated systolic hypertension?

Answer 5

140 or higher / 90 or lower

Question 6

What is the range of isolated systolic hypertension with widened pulse pressure?

Answer 6

160 or higher / 70 or lower

Question 7

What is the target BP for HPT pt with no other condition?

Question 8

For which HPT pt is the target BP

Answer 8

For HPT pt with CHD/chronic kidney disease/proteinuria >300mg/day/ stroke/ TIA

Question 9

For HPT pt with proteinuria of greater than 1g per day, what is the target BP?

Question 10

When do we CONSIDER anti hypertensives??

Answer 10

Grade 2 hypertension (moderate)
Family history
Indigenous

Question 11

When do we START antihypertensive??

Answer 11

Grade 3 HPT
Isolated systolic hypertension with widened pulse pressure
HIGH ABSOLUTE RISK (>15%) -if over 75 years old, has CVD, Or any end organ disease

Question 12

what meds can increase the BP??

Answer 12

Corticosteroids (fluid retention), NSAIDs, haemopoietic agents, immunomodifiers, conc, oral decongestants, SNRI (increase NA level which increases BP), illicit drugs, leflunomide

Question 13

How can hydrochlorothiazide be used in different doses?

Answer 13

At low doses 25mg, it is used to decrease BP

At higher doses, it is used for dieresis effect

Question 14

How to start antihypertensive and how to add or change drugs

Answer 14

Start with lowest dose for single drug
Then add second drug with lowest dose
Increase first drug dose
Increase second drug dose
Change to a different class with washout period or 3rd drug
Wait for more than 6months for effect

Question 15

What drug can be used for African origin?

Answer 15

Thiazides

Question 16

What should we be careful with thiazides?

Answer 16

Younger people (age below 65years)
Diabetes (high glucose tolerance)
Gout
Using with metoprolol (it can mask the sx of hypoglycaemia in type 1 diabetes)

Question 17

What does ACEI lead to secretion of?

Answer 17

Aldosterone (increase sodium and water retention, potassium excretion)

Question 18

ACEI is a first line In Chronic kidney disease. But monitoring is crucial
How do you control ACEI use by monitoring eGFR?

Answer 18

If eGFR is reduced by less than 25 %, stabilised for 2 mths, then continue
If it is reduced by more than 25%, then discontinue as it might lead to renal artery stenosis

Question 19

What are the counselling points for ACEI?

Answer 19

TAke first dose at night due to hypotension
Separate the ACEI doses with diuretics
It can cause angioedema and dry cough
Avoid taking NSAIDS as well it causes afferent ARTERIOLES constriction (leads to massive drop of BP in glomerulus and knock out of kidney)

Question 20

Which CCB is more powerful?

Answer 20

Dihydropyridines

Question 21

Which CCB can be used in angina and which should be avoided?

Answer 21

Use non-dihydropyridines (diltiazem, verapamil )

Avoid dihydropyridines in angina and MI

Question 22

How can non-dihydropyridines be used in angina?

Answer 22

Cardiac activity triggered by these meds can prevent reflex tachycardia

Question 23

Which class can be used in MI, HF and diabetes with monitoring that is not as effective as the first line?

Answer 23

Beta blockers

Question 24

Which BB is b1 selective?

And what does this mean?

Answer 24

Atenolol, metoprolol

These can be used in asthma

Question 25

Which BB is renally cleared? Aka water soluble

Answer 25

Atenolol and sotalol

Question 26

What are some of the ADE caused by BB

And how do you decrease the dose in HF?

Answer 26

Dizziness, impotence, cold fingers and toes due to blocking beta action
When reducing the dose, do it over at least 2 weeks
In HF, halve a dose each week as sudden withdrawal may exacerbate angina

Question 27

What happens to the aldosterone level if you use Sartan?

Answer 27

The aldosterone level decreases, vessel dilates and decreases heart contraction

Question 28

What is the term meaning hypertension before pregnancy?

Answer 28

Chronic hypertension

Superimpose pre eclampsia

Question 29

What is the term meaning hypertension after 20 weeks of pregnancy? Existence of proteinuria?

Answer 29

Gestational

No proteinuria

Question 30

What is hypertension after 20weeks of pregnancy with proteinuria?
What’s its risk??

Answer 30

Pre-eclampsia
They may have peripheral oedema
It rarely progresses to eclampsia (unexplained seizure) but it is dangerous

Question 31

What antihypertensive can be used in pregnancy?

Answer 31

Non selective BB - labetalol oxprenolol
CCB - nifedipine
Centrally acting. A2 agonist - methyldopa (but can cause depression)

Question 32

What antihypertensive can be used in breastfeeding women?

Answer 32

Most BB except for atenolol

CCB - nifedipine

Question 33

What is the best combination for diabetes pt?

Answer 33

ACEI/ SARTAN with CCB

NOT thiazides

Question 34

For pt with HF and post stroke, what is good to be used with ACEI?
What about for pt with HF and post MI?

Answer 34

Post stroke - Thiazides

Post MI. - BB

Question 35

What combination of antihypertensive should we avoid?

Answer 35

ACEI with potassium sparing diuretic as they both increase potassium level
Verapamil with BB can cause heart block