Hypertension

Question 1

Home BP monitoring

Answer 1

2 x a day for a week
Do each recording twice, 1 minute apart, whilst sat down

Discard 1st day recording
Take average of the rest

Question 2

Ambulatory BP monitoring

Answer 2

Every half an hour for one day

Question 3

Which Qrisk score indicates anti-hypertensives should be commenced?

Answer 3

> 20%

>10% start arvostatin

Question 4

What is 1st line treatment for a caucasian <55 who does not tolerate ACE-i? Starting and max dose

Answer 4

ARB - losartan
Starting dose = 2.5mg (same for CCB)
Max dose = 10mg (same for CCB)

Question 5

What medications will be used in steps 2 of HTN management?

Answer 5

A + C

ACE-i and Calcium channel blockers (amlodipine)

Question 6

What is step 3 for management of HTN?

Answer 6

D - thiazide like diuretic (indapamide)
Starting dose = 1.25mg
Max dose = 5mg
(i.e. half of ACE-i and CCB)

Question 7

Step 4 for management of HTN?

Answer 7

High dose thiazide-like diuretic (indapamide) or low dose spironolactone

Question 8

Step 4 management of HTN?

Answer 8

Consider B-blockers and a-blockers

Question 9

What should be used as first line treatment of HTN in women of child bearing age or those who do not tolerate ARB or ACE-i?

Answer 9

B-blockers

Question 10

Investigative ladder to diagnose HTN?

Answer 10

1. BP
2. ABPM - average value of 14 recordings
   or HBPM if ambulatory is not possible
3. urgent referral if BP >180/110 with papilloedema +/- retinal haemorrhage

Question 11

What else should be assessed when investigating HTN?

Answer 11

CV risk: ECG + Qrisk2 (%risk of heart or stroke in 10 years)

Kidney risk:
Bloods - serum eGFR, glucose, U+Es, creatinine
Urine - ACR (>1 indicates early kidney disease)

Eyes - ophthalmoscope

Question 12

What combinations of anti-HTN should be avoided?

Answer 12

ACE-i + ARB
diuretic + B-blocker
(aggravates DM)

Question 13

Side effects and CI of ACE-i?

Answer 13

Side effects:
Postural HTN
Dry cough
Dyspnoea
Rash

CI:
Aortic stenosis
Pregnancy (affects foetal BP)

Question 14

Drug interactions of ACE-i?

Answer 14

ARB + Spironolactone –> increased serum potassium

Question 15

Side effects and CI of ARBs?

Answer 15

SE - dizziness

CI - pregnancy + BF

Question 16

SE and CI off CCBs?

Answer 16

SE:
Ankle oedema
(Headache, palpitations, nausea and dizziness)

CI:
HF (decreases contraction)
AV block/severe bradycardia

Question 17

Drug interactions of CCBs?

Answer 17

BB –> hypotension and Av block

Digoxin –> toxicity

Question 18

Thiazide like diuretic SE and CI?

Answer 18

SE: hypokalemia
(Headache, dizziness/postural hypotension)
Causes uric acid accumulation

CI:
Hypokalemia/natremia
Addison’s disease
Gout + SLE (uric acid)

Question 19

Drug interactions of thiazides?

Answer 19

Digoxin –> hypokalaemia and dysrhythmia

Question 20

K sparing diuretics SE and CI?

Answer 20

SE - Gynaecomastia, impotence, menstrual irregularity

CI - hyperkalemia/natremia, Addison’s

Question 21

Annual review

Answer 21

BP reading
BMI
Medications: name, dose, compliance, SE, efficacy

Question 22

Red flag symptoms in HTN?

Answer 22

Phaeochromocytoma - tumour of adrenal glad causes accelerated HTN –> headache, palpitations, pallor, sweating, postural hypotension

Severe/malignant HTN –> headache, epistaxis, nocturia, dyspnoea (LVF) (N+V, reduced UO, fatigue, restless, weakness)