Hypertension

Question 1

Describe the NICE antihypertensive treatment flowchart

Answer 1

Aged <55 or NOT of Caribbean/African origin:

1) ACEi (or ARB if ACEi is not tolerated or contraindicated)
2) CCB
3) Thiazide-like diuretic
4) Confirm resistant hypertension and seek expert advice

Aged > 55 or African/Caribbean origin:

1) CCB
2) ACEi (or ARB if ACEi is not tolerated or contraindicated)
3) Thiazde-like diuretic
4) Confirm resistant hypertension and seek expert advice

Question 2

Give 2 examples of an ACE inhibitor

Describe the mechanism of action

Answer 2

Examples: Ramipril, Lisinopril

Mechanism of action:

• Inhibits conversion of angiotensin I to angiotensin II
• This reduces vasoconstriction and peripheral vascular resistance

Question 3

Give 2 examples of an ARB

Describe the mechanism of action

Answer 3

Examples: Losartan, Candesartan

Mechanism of action:

• Block the action of angiotensin II on its receptor
• This reduces vasoconstriction and peripheral vascular resistance, reducing BP

Question 4

Give 2 examples of calcium channel blockers

Describe the mechanism of action

Answer 4

Examples: Amlodipine (dihydropyridine) and Verapamil (non-dihydropyridine)

Mechanism of action:

• Reduces entry of calcium ions into vascular/cardiac cells
• This causes vasodilation/reduced myocardial contractility
• Dihydropyridines are more selective for the vasculature, whereas non-dihydropyridines are more selective for the heart

Question 5

Give 2 examples of thiazide-like diuretics

Describe the mechanism of action

Answer 5

Examples: bendroflumethiazide, indapamide

Mechanism of action:

• Inhibits sodium-potassium pump in the DCT
• This inhibits reabsorption of sodium, leading to diuresis

Question 6

Give 2 side effects of ACE inhibitors

Answer 6

• Dry cough

- Hypotension

Question 7

Give 3 side effects of CCBs

Answer 7

• Peripheral oedema
• Constipation
• Hypotension

Question 8

Give 3 side effects of thiazide-like diuretics

Answer 8

• Urinary frequency
• Hyponatraemia
• Hypotension