Hypertension and Heart Failure

Question 1

What is HTN?

Answer 1

High blood pressure

Question 2

What target clinic blood pressure would you want for someone under 80 years old?

Answer 2

Below 140/90

Question 3

What are the two types of blood pressure monitoring?

Answer 3

Ambulatory (tends to be higher) and home-blood pressure monitoring

Question 4

What is Stage 1 HTN?

Answer 4

BP >135/85 home blood pressure monitoring (HBPM)

Question 5

If patient is less than 40 years with no other co-morbidity, what should they be evaluated for?

Answer 5

Look for secondary causes of HTN

Question 6

What is Stage 2 HTN?

Answer 6

BP >150/95 (HBPM)

All patients must be treated regardless of their age

Question 7

If a patient is under 55 and have HTN, which drugs would be given? if contraindicated, what else would you give?

Answer 7

Step 1: ACEI or ARB

BB if contraindicated

Question 8

If patient still has HTN, whats the next course of action?

Answer 8

Step 2: Keep pt on ACE or ARB but add CCB (if not tolerated or at risk of HF) add thiazide related diuretic (indapamide or chlortalidone)

Step 3:
ACE/ARB + CCB + thiazide related diuretic

Step 4: Give all of the above + low dose of spironolactone or increase thiazide dose if plasma conc was above 4.5mmol/L

If diuretic therapy was contraindicated - give alpha or beta blocker instead

Question 9

If patient is above 55 or afro-caribbean, what would be the course of action?

Answer 9

Step 1: CCB (if not tolerated) - would give thiazide related diuretic
Step 2: CCB (or TD) + ACE/ARB
If Afro-carribean (ARB would be given in preference to ACE)

Step 3: CCB + ACE/ARB + TD

STEP 4: ^ + low dose of spironolactone and increase TD

Question 10

Which drugs are used for patients who are pregnant?

Answer 10

Methyldopa or labetolol

Question 11

What other classes of antihypertensive drugs are there?

Answer 11

Vasodilator antihypertensive drugs, centrally acting antihypertensive drugs, alpha-adrenoceptor blocking drugs and adrenergic-neuro blocking drugs

Question 12

What are vasodilator antihypertensive drugs?

Answer 12

v.potent hypertensive effect

Hydralazine

Question 13

What are centrally acting antihypertensive drugs?

Answer 13

Methyldopa

Question 14

What are alpha-adrenoreceptor blocking drugs?

Answer 14

Prazosin, Doxazosin

Question 15

what would you counsel a patient on in terms of starting antihypertensives?

Answer 15

First dose usually drops BP down a lot, so use with caution