Hypertension

Question 1

Outline the ACD algorithm from the British Hypertensive Society for the treatment of hypertension

Answer 1

Less than 55 or Type 2 diabetes: first step ACEI or ARB
Over 55 or Afro-Caribbean: first step calcium channel blocker

Step 2: Add ACEI/ARB or calcium channel blocker or thiazide-like diuretic
Step 3: ACEI AND calcium channel blocker, AND thiazide diuretic
Step 4: Seek expert advice

Question 2

What are the common side effects of calcium channel blockers?

Answer 2

Flushing
Headaches
Ankle swelling

Question 3

What are the indications for the treatment of Grade 1 (mild) hypertension?

Answer 3

Less than 80 and any of the following:
End organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk (QRISK) 10%+

Question 4

What are the side effects of thiazide diuretics?

Answer 4

Hypokalaemia
Hyponatraemia
Hypercalcaemia
Gout
Impaired glucose tolerance

Question 5

What should be suspected if there is a sudden and significant deterioration in renal function after starting ACE inhibitors?

Answer 5

Renal artery stenosis

Question 6

What are the acceptable change in renal function after starting ACE inhibitors?

Answer 6

Potassium increase up to 5.5
Serum creatinine increase up to 30% above baseline

Question 7

Name two medications used in the management of orthostatic hypertension

Answer 7

Fludrocortisone
Midodrine

Question 8

What is meant by Stage 1 hypertension?

Answer 8

> =135/85

Question 9

What is meant by Stage 2 hypertension?

Answer 9

> =150/95

Question 10

At what potassium level can you add Spironolactone?

Answer 10

Equal to or less than 4.5