Hypertension

Question 1

What is step 1 treatment for under 55’s?

Answer 1

Either and ACE inhibitor or a ARB (angiotensin receptor blocker)

Question 2

Give an example of a ACE inhibitor used

Answer 2

Ramipril

Question 3

Give examples of ARB’s that are used.

Answer 3

Losartan and Valsartan

Question 4

What does ARB stand for?

Answer 4

Angiotensin receptor blocker

Question 5

What is step 1 treatment in over 55’s?

Answer 5

Give a CCB or if the CCB can’t be used use a Thiazide-type diuretic.

Question 6

When would you not use a CCB?

Answer 6

If there is evidence of heart failure or a high risk of heart failure.

Question 7

What groups of under 55’s do you not give ARB’S or ACEi?

Answer 7

Women of child bearing age (as both of these types of drug are teratogenic).
Or people of Afro-Caribbean origin (as they are salt retainers)

Question 8

What is step 2 treatment?

Answer 8

Add a Thiazide-type diuretic to the anti-hypertensive the patient is already on.

Question 9

What is step 3 treatment?

Answer 9

Add a CCB, ACEI and Diuretic together.

Question 10

What is Step 4 treatment?

Answer 10

For resistant hypertension- consider further diuretic therapy such as a low dose spironolactone if K blood levels are lower than 4.5 mmol or lower and they don’t have reduced GFR.

If they have K blood levels of higher than 4.5mmol use a higher dose thiazide-type diuretic.

Question 11

What are the adverse drug reactions you can get from ACEi’s or ARB’s?

Answer 11

Cough (not ARB's)
First dose hypotension
Taste disturbance
Renal impairment
Angioneurotic oedema