Hypertension

Question 1

Mr R.T. is a 59 year old man who comes to see you in the Well Man clinic. He has no symptoms and urine dipstick testing is negative. His blood pressure is 150 systolic, 98 phase 5 diastolic.

Answer 1

-

Question 2

Q1) What is meant by Phase 5?

Answer 2

The pressure at which the sound disappears

Question 3

Q2) What will be your initial approach to this blood pressure result? Give
two examples of your next course of action?

Answer 3

• Measure it again in order to minimise the risk of white-coat hypertension
• Offer Ambulatory Blood Pressure Monitoring or Home Blood Pressure
  Recording to dx HTN

Question 4

Q3) You later decide to treat his raised blood pressure, but Mr R.T. is unhappy about long term drug treatment and asks what benefits are likely. Suggest 2 long-term advantages?

Answer 4

• Reduced chance of having a stroke
• Reduced chance of having a myocardial infarction
• Reduce risk of developing Heart Failure
• Reduced mortality

Question 5

Q4) What drug treatment will you consider? Suggest 3 classes of drugs likely to be most useful?

Answer 5

• Angiotensin Converting Enzyme Inhibitors
• Calcium Channel Blockers
• Diuretics (Thiazide-like)

Question 6

Q5) Mr R.T. asks you about the side effects of the drugs that you propose to use. List 1 common side effect for each class of drug in your previous answer?

Answer 6

• ACE-I → cough, first-dose severe hypotension
• Ca-Channel Blockers → ankle swelling, headache
• Diuretics → hypokalaemia, gout (impairs urate secretion)