Hypertension

Question 1

What two symptoms might indicate a secondary cause of hypertension?

Answer 1

Haematuria (glomerulonephritis, obstructing urinary tract pathology)
Nocturia (reduced renal function)

Question 2

What is the mechanism of action of ACE inhibitors?

Answer 2

Reducing levels of the vasoconstrictor, angiotensin II, by reducing the conversion of AI to AII. Increasing levels of vasodilator kinins, causing arteriolar and to a lesser extent venular dilatation, reducing aldosterone secretion which causes naturesis.

Question 3

What is the suffix of the ACE inhibitors?

Answer 3

• pril

e. g. perindopril etc.

Question 4

What is the mechanism of action of the Sartans?

Answer 4

Angiotensin II receptor antagonists. Reduce angiotensin-induced vasoconstriction, sodium reabsorption and aldosterone release.

Question 5

How are the angiotensin II receptor antagonists excreted?

Answer 5

Hepato-biliary excretion

Question 6

Under what circumstances are beta-blockers indicated?

Answer 6

Recommended for hypertension when there are compelling indications, such as angina. Also after MI.
Not recommended for uncomplicated hypertension.

Question 7

Name three examples of calcium channel blockers

Answer 7

Amlodipine
Diltiazem
Verapamil

Question 8

What two classes are the calcium channel blockers divided into?

Answer 8

Dihydropiridines

non-dihydropiridines

Question 9

Name two non-dihydropiridines

Answer 9

Diltiazem, verapimil

Question 10

Name four dihydropiridines

Answer 10

nifedipine, felodipine, lercanidipine and amlodipine

Question 11

What is the difference between the dihydropiridines and the non-dihydropiridines?

Answer 11

Dihydropiridines are more peripherally acting than the non-dihydropiridines. Non-dihydropiridines can depress the sino-atrial and atrio-ventricular nodes and conducting system, which can lead to significant bradycardia.

Question 12

Examples of thiazide/ thiazide like diuretics?

Answer 12

Thiazides:

• Hydrochlorothiazide
• Chlorothiazide
• etc etc

Thiazide like:

• Chlorthalidone
• Indapamide

Question 13

Potassium sparing diuretics? (3)

And Type

Answer 13

Aldosterone antagonists

• Spironolactone
• Eplerenone

Epithelial Na Channel Blocker:
- Amiloride

Question 14

For which patients are beta-blockers contraindicated?

Answer 14

Patients with asthma

Question 15

In which patients are thiazide diuretics considered for first line treatment of hypertension?

Answer 15

Those aged >65 years in whom the benefits of managing isolated systolic hypertension and preventing stroke with these agents are likely to outweigh the risk of diabetes onset.

Question 16

Why are thiazide diuretics not considered for treatment of hypertension in young patients?

Answer 16

They are associated with an increased risk of new-onset diabetes

Question 17

What are three first line treatment options for uncomplicated hypertension?

Answer 17

ACE inhibitor, angiotensin II-receptor antagonist or dihydropyridine calcium channel blocker

Question 18

In patients with proteinuria >1 g/day (with or without diabetes), what is the recommended BP target?

Answer 18

125/75 mmHg

Question 19

Which class of antihypertensive drug is contraindicated in patients with heart failure?

Answer 19

Calcium channel blockers. There is a risk of further depression of cardiac function.

Particularly in HFrEF

Question 20

What percentage of patients with hypertension will not reach target BPs on monotherapy?

Answer 20

50-75%

Question 21

What is the most effective combination of drugs for the treatment of hypertensive patients who fail to reach target BPs on monotherapy?

Answer 21

ACE-inhibitor (or Angiotensin II receptor blocker) and calcium channel blocker