Hypertension

Question 1

According to CG127 what are the diuretics of choice?

Answer 1

Indapamide or Chlortalidone

Question 2

Patients who are well controlled on which drug can be allowed to remain taking it?

Answer 2

Bendroflumethiazide.

Question 3

Smoking has what effect on blood pressure?

Answer 3

Temporarily increases it at time of smoking a cigarette but has no long term impact. Recommended to stop as it has other cardio risks.

Question 4

What are the modifiable risk factors for hypertension?

Answer 4

BMI
Lipid levels
Smoking levels
Blood pressure

Question 5

What is the HOME blood pressure target for those under 80 years of age?

Answer 5

Below 135/85mmHg

Question 6

What is the HOME blood pressure target for those over 80 years of age?

Answer 6

Below 145/85mmHg

Question 7

What is the clinic BP target for those aged under 80?

Answer 7

Below 140/90mmHg

Question 8

What is the clinic BP target for those aged over 80?

Answer 8

Below 150/90mmHg

Question 9

Antihypertensive treatment should be offered to people under 80 with stage 1 hypertension AND what? [5]

Answer 9

Target organ damage. 
Established cardiovascular disease.
Renal disease. 
Diabetes. 
A 10-year cardiovascualr risk of higher than 20%

Question 10

Why would people under 40 years of age with stage 1 hypertension be referred to specialists?

Answer 10

This is because 10-year cardiovascular risk assessments can underestimate the lifetime risk of cardiovascular events in these people.

Question 11

What is the definition of stage 1 hypertension?

Answer 11

Clinic >140/90mmHg.

At home >135/85 mmHg

Question 12

What is the definition of stage 2 hypertension?

Answer 12

Clinic >160/100mmHg

At home >150/95mmHg

Question 13

What is the definition of SEVERE hypertension?

Answer 13

Clinic systolic blood pressure >180 or diastolic >110mmHg.

Question 14

If the systolic blood pressure of a person falls by 20mmHg or more when they are standing what must be done? [3]

Answer 14

Review medication.
Measure subsequent BP with person standing.
Consider referral if systoms of postural hypotension persist.

Question 15

What should be done if a person has a clinic BP of 140/90mmHg or higher? [2]

Answer 15

1. ABPM to confirm presence of hypertension. (unless severe, in which case: start treatment)
2. Investigate for any target organ damage and CVD risk.

Question 16

What treatment should someone under 55 with hypertension be offered?

Answer 16

ACEI or low cost ARB.

If ACEI not tolerated use ARB.

Question 17

Can ACEI and ARB be used in conjunction to treat hypertension?

Answer 17

No

Question 18

What should someone of afrocarribean origin be offered as treatment for hypertension?

Answer 18

CCB or thiazide-like diuretic (chortalidone or indapamide)

Question 19

If BP is not controlled by step 1 treatment what is step 2?

Answer 19

CCB +ACEI or ARB

Question 20

If BP is not controlled by step 1 treatment what is step 2 if CCB are not tolerated?

Answer 20

Thiazide-like diuretic such as chortalidone or indapamide and ACEI or ARB.

Question 21

CCB or thiazide-like diuretic is the treatment for

Answer 21

Hypertension in those over 55 or black.

Question 22

If BP is not controlled by step 1 treatment what is step 2 for those of afro-carribean origin?

Answer 22

CCB + ARB in preference to ACEI.

Question 23

Why would beta blockers be used as initial therapy for hypertension? [4]

Answer 23

Younger people:
Intolerance to ACEI and ARB.
Women of child bearing potential.
People with evidence of increased sympathetic drive.

Question 24

If therapy is initiated with a beta-blocker and a second drug is required what class should be used and why?

Answer 24

CCB instead of thiazide-like diuretic to reduce chance of developing diabetes.

Question 25

If BP is still not controlled after step 1 and step 2 treatment options what must occur?

Answer 25

Medication review.

Question 26

If BP is still not controlled after step 1 and step 2 treatment options what can be used as treatment?

Answer 26

IF three drugs needed: | ACEI or ARB + CCB + thiazide-like diuretic.

Question 27

What is resistant hypertension?

Answer 27

BP >140/90mmHg after treatment with optimal doses of ACEI or ARB + CCB + thiazide-like diuretic.

Question 28

How is resistant hypertension treated?

Answer 28

Low-dose spironolactone if the potassium level is 4.5 or lower. Higher dose thiazide-like diuretic if the potassium is higher than 4.5.

Question 29

What new monitoring must occur during treatment of resistant hypertension?

Answer 29

When using further diuretic therapy for resistant hypertension at step 4, monitor blood sodium and potassium and renal function within 1 month and repeat as required thereafter.

Question 30

What drug class is used to treat resistant hypertension in those people who cannot tolerate further diuretic therapy?

Answer 30

Alpha or beta blocker.

Question 31

When would low-dose spironolactone be used to treat resistant hypertension?

Answer 31

If K+ is 4.5 or lower.

Question 32

When would high-dose thiazide-like diuretic be used to treat resistant hypertension?

Answer 32

If K+ is >4.5

Question 33

An appropriate dose of an appropriate drug for initial treatment of stage 2 hypertension is:

Answer 33

5mg Amlodipine or other CCB

Question 34

What is the target BP for someone diagnosed with stage 2 hypertension?

Answer 34

140/90 in clinic, | 135/85 at home

Question 35

What counselling is needed for CCB?

Answer 35

Swollen ankles means need to switch to alternative drug class.

Question 36

When would a review of someone newly diagnosed with stage 2 hypertension and prescribed 5mg Amlodipine need to be carried out?

Answer 36

Within a month, check BP and occurrence of side effects.

Question 37

What is the treatment for stage 2 hypertension in T2 diabetic?

Answer 37

ACEI or ARB, Ramipril etc.

Question 38

ACEI cause hyponatremia

Answer 38

true

Question 39

ACEI cause hyperkalemia

Answer 39

True

Question 40

ACEI cause hypernatremia

Answer 40

false

Question 41

ACEI cause hypokalemia

Answer 41

false

Question 42

ACEI cause what electrolyte imbalances?

Answer 42

low sodium | high potassium

Question 43

How do ACEI cause hyperkalemia?

Answer 43

Suppression of angiotensin II leads to a decrease in aldosterone levels. Since aldosterone is responsible for increasing the excretion of potassium, ACE inhibitors can cause retention of potassium

Question 44

Why is the second treatment step for afrocarribean a CCB + ARB, in preference to an ACEI?

Answer 44

They have lower renin levels.