Hypertension

Question 1

What is Resistant Hypertension?

Answer 1

> 140/90 after step 3 of treatment

Question 2

How is Resistant Hypertension treated?

Answer 2

Either refer to specialist
OR
Spironolactone if K high
OR 
High dose Thiazide

Question 3

What are target BPs in hypertension?

Answer 3

>80 = 150/90
<80 = 140/90

Question 4

What bloods must you check before starting ACEi?

Answer 4

U and E

Question 5

What is stage 1 hypertension?

Answer 5

140/90 in clinic

135/85 ambulatory

Question 6

What stage do you start hypertension treatment at?

Answer 6

Stage 2 regardless of age (bp 150) if no cormorbidities

If there are comorbidities start at 140

Question 7

What is stage 2 hypertension?

Answer 7

160/100

150/95 ambulatory

Question 8

What is stage 3 (severe) hypertension?

Answer 8

> 180 in clinic

>110

Question 9

What investigation indicated in severe hypertension

Answer 9

Fundoscopy

Question 10

What is the risk score used to decide on statins?

Answer 10

QRisk2

Question 11

What is lifestyle advice offered to people with hypertension?

Answer 11

Weight Loss
Excercise
Lower sodium
Reduce alcohol and caffeine intake
Stop smoking
Check cholesterol

Question 12

What investigations should be done in all hypertension?

Answer 12

ECG
BMI
Blood glucose

Question 13

How should you respond to severe hypertension in clinic?

Answer 13

Treat immediately

Assess carefully for neurological signs

Question 14

What is the 1st and 2nd and 3rd line management of hypertension for under 55 year old man?

Answer 14

1st line= ACEi or ARB
2nd line= ACEi (or ARB) + CCB
3rd line= ACEi + CCB + Thiazide like Diuretic

Question 15

What is the 1st and 2nd and 3rd line management of hypertension in an afro caribbean man over 55?

Answer 15

1st line= CCB
2nd line= ACEi + CCB
3rd line= ACEi + CCB + Thiazide like Diuretic

Question 16

When do patients generally notice symptoms in hypertension?

Answer 16

Not until organ damage

Question 17

When would you start pharmacological treatment for stage 1 hypertension?

Answer 17

Over 50
Organ damage
DM

Question 18

What are some causes of secondary hypertension?

Answer 18

Cushings
Renal Disease
Conns
Phaeochromocytoma
Hyperparathyroidism
Pregnancy
(Alcohol and obesity)

Question 19

What investigations would you do in hypertension?

Answer 19

Cr
Electrolytes
eGFR
Glucose
HbA1c
Lipid Profile
Urine
ECG and echo if risk

Question 20

When would you offer a statin?

Answer 20

In CVD and hypertension
OR
>40 with hypertension and 10 year CVD risk of 20%

Question 21

Name some CCBs

Answer 21

Amlodipine

Nifedipine

Question 22

Name some ACEi

Answer 22

Enalapril
Ramipril
Lisinopril

Question 23

Name some ARBs

Answer 23

Losartan

Condesartan

Question 24

What is a risk of a Thiazide like diuretic?

Answer 24

Pitting Oedema and Gout

Question 25

What must be checked before starting statin therapy?

Answer 25

LFTs

Question 26

When should you review in hypertension?

Answer 26

1 month after starting meds then evert 3-6 months

Question 27

What is the mechanism of action of ACEi?

Answer 27

Vasodilators

Decrease ECF volume by reducing Aldosterone

Question 28

What are side effects of ACEi?

Answer 28

Bradykinin cough
Angioedema
Hypokalaemia due to action on Aldosterone

Question 29

What is the mechanism of Thiazide like Diuretics?

Answer 29

Stop aldosterone release from adrenal medulla therefore reducing expression of the ENaC in distal tubule

Question 30

What is the mechanism of action of CCBs?

Answer 30

Vasodilate

Reduced tachycardia

Question 31

What is polypharmarcy

Answer 31

More than 4 drugs in those over 65

Question 32

What is the impact of polypharmacy?

Answer 32

Increased ADRs
Costs
Less adherence