Hypertension

Question 1

Stage 1 hypertension is defined as….

Answer 1

Clinic BP 140/90 or higher

or home BP 135/85 or higher

Question 2

When should you treat someone with stage 1 hypertension?

Answer 2

Treat patients under 80 years who have stage 1 hypertension and target organ damage, cardiovascular disease, renal disease, diabetes or .a 10 year CV risk >20%. In the absence of these conditions advise lifestyle changes. For patients under 40 years consider seeking specialist advice for secondary causes of hypertension

Question 3

Stage 2 hypertension is defined as….

Answer 3

Clinical BP of 160/100 or higher

or home BP 150/95 or higher

Question 4

When should you treat someone with stage 2 hypertension?

Answer 4

Treat all patients who have stage 2 hypertension regardless of age

Question 5

Target BP for patients with CKD and HTN

Answer 5

<130/80

Question 6

First line anti HTN in caucasian patients under 55 years

Answer 6

ACEi

if not tolerated an ARB. If both not tolerated, consider a beta blocker

Question 7

Why should beta blockers and thiazide like diuretics be avoided for the routine treatment of uncomplicated hypertension in patients with diabetes?

Answer 7

beta blockers can impair glucose metabolism

thiazide like diuretics can increase glucose levels

Question 8

Second line treatment for hypertension <55 years (Caucasian)

Answer 8

ACEi or ARB in combination with a calcium channel blocker

If CCB is not tolerated or there is high risk of heart failure give a thiazide like diuretic. If a betablocker was given in step 1, add a CCB in preference to a thiazide like diuretic

Question 9

Step 3 treatment for hypertension in a Caucasian patient <55 years

Answer 9

ACE inhibitor or angiotensin-II receptor antagonist in combination with a calcium-channel blocker and a thiazide-related diuretic

Question 10

First line treatment for hypertension in patients over 55 years, and patients of any age who are of African or Caribbean family origin

Answer 10

Calcium-channel blocker; if not tolerated or if there is evidence of, or a high risk of, heart failure, give a thiazide-related diuretic (e.g. chlortalidone or indapamide)

Question 11

Second step of treatment for hypertension over 55 years, and patients of any age who are of African or Caribbean family origin

Answer 11

Calcium-channel blocker or thiazide-related diuretic in combination with an ACE inhibitor or angiotensin-II receptor antagonist (an angiotensin-II receptor antagonist in combination with a calcium-channel blocker is preferred in patients of African or Caribbean family origin)

Question 12

Target BP in patients over 80 years

Answer 12

A target clinic blood pressure below 150/90 mmHg is suggested for patients over 80 years; the suggested target ambulatory or home blood pressure average (during the patient’s waking hours) is below 145/85 mmHg.

Question 13

Target BP in patients with diabetes

Answer 13

For patients with diabetes, a target clinic blood pressure below 140/80 mmHg is suggested (below 130/80 mmHg is advised if kidney, eye, or cerebrovascular disease are also present).

Question 14

Antihypertensives recommended in pregnancy….

Answer 14

labetalol, methyldopa, and nifedipine

Question 15

Which CCB should be avoided in heart failure? why?

Answer 15

Verapamil hydrochloride and diltiazem hydrochloride should usually be avoided in heart failure because they may further depress cardiac function and cause clinically significant deterioration

Question 16

Nimodipine is a CCB, its use is confined to what indication? why?

Answer 16

Nimodipine is related to nifedipine but the smooth muscle relaxant effect preferentially acts on cerebral arteries. Its use is confined to prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage

Question 17

How should stable angina be treated?

Answer 17

Patients with stable angina should be given a beta-blocker or a calcium-channel blocker. In