Hypertension

Question 1

What are the most common side effects of statins?

Answer 1

(myopathy) muscle aches

also effects liver so do baseline LFTs, recheck LFTs in 3 months

Question 2

What is the difference between htn and high blood pressure?

Answer 2

htn is over a prolonged period of time

Question 3

What ix confirm a diagnosis of htn?

Answer 3

If BP over 140/90 then repeat measurement
offer ambulatory blood pressure monitoring (ABPM) or HBPM to confirm the diagnosis of hypertension - 135/85 must be the average result - eliminates white coat htn

Question 4

How long does home vs ambulatory BP take?

Answer 4

Home - over a week

Ambulatory- over a day

Question 5

What follow up ix should you do for htn?

Answer 5

test for proteinuria by sending a urine sample for estimation of the albumin: creatinine ratio and test for haematuria using a reagent strip
HbA1C, electrolytes, creatinine, GFR, lipid profile, serum sodium, potassium, calcium, TSH
examine the fundi for the presence of hypertensive retinopathy
ECG

Question 6

What are the different stages of htn?

Answer 6

stage 1: clinic BP of 140/90 mmHg to 159/99 mmHg
stage 2: 160/100 - 180/120
stage 3/ severe: >180/120

Question 7

What is the difference between essential and secondary htn?

Answer 7

Essential hypertension (primary, cause unknown- from diet, stress, weight etc.) accounts for the majority of cases, particularly in the older patient.

Secondary hypertension is commonly caused by renal disease, endocrine conditions or pregnancy – think maybe if young and not overweight

Question 8

What is the mx of type 1 vs type 2 htn?

Answer 8

type 1: lifestyle advice (unless target organ damage, cardio or renal disease, DM, Qrisk3 10% or more then treat)
type 2: offer anti-htn drugs

Question 9

What is the lifestyle advice for htn?

Answer 9

alcohol (below 14 units a week), diet (DASH), less caffeine, less sodium, more potassium, smoking cessation, exercise (150 mins/ 70 more vigorous)

Question 10

Describe the ACD pathway?

Answer 10

1. < 55 yr: ACE- or ARB
2. > 55 yrs / afrocarribean heritage: CCB
3. A + CCB
4. A + C + Diuretic (thiazide-like OR Spironolactone is K below 4.5)
5. referral

Question 11

What is first line Rx for ACE-inhibitors in htn?

Answer 11

Rampiril

Question 12

What are the most common side effects of ACE-i?

Answer 12

check U+Es as affects kidneys

can get cough - switch to ARB if this happens

Question 13

What is the fIrst line CCB for htn?

Answer 13

Amlodipine

Question 14

What is the most common SE of CCB?

Answer 14

swollen ankles

Question 15

What is the first line diuretic for htn?

Answer 15

Indapamide (thiazide-like)

Question 16

What are the targets for blood pressure in over 80s, under 80s and DM?

Answer 16

Below 140/90 mmHg if aged under 80.
Reduce clinic blood pressure to below 150/90 mmHg if aged 80 and over.
Aim for 135/85 mm Hg in DM

Question 17

Why are the elderly more at risk of orthostatic hypotension?

Answer 17

The baroreflex mechanisms which control heart rate and vascular resistance decline with age (particularly in patients with hypertension) who thus display lability in BP