Hypertension (finals)

Question 1

What is the definition of hypertension

Answer 1

Clinic reading above >140/90

OR

A 24 hour blood pressure average of >135/85

Question 2

What investigations should be done to check for end organ damage if someone is hypertensive

Answer 2

Fundoscopy - Hypertensive retinopathy
Urine dipstick - Renal disease (as a cause or consequence of HTN)
ECG - To check for LVH or IHD

Question 3

What is an ACE inhibitor

Answer 3

Inhibits the conversion of angiotensin I to angiotensin II

End in ‘pril’

Question 4

What are the side effects of ACE inhibitors

Answer 4

Cough
Angioedema
Hyperkalaemia

*Check renal function 2-3 weeks after starting due to the risk of worsening renal function in those with kidney disease

Question 5

What are calcium channel blockers

Answer 5

They block voltage-gated calcium channels which relaxes vascular smooth muscle and relaxes the force of myocardial contraction.

Question 6

What are the side effects of calcium channel blockers

Answer 6

Flushing
Angle swelling
Headache

Question 7

What are thiazide type diuretics

Answer 7

They inhibit sodium absorption at the beginning of the distal convoluted tubule

Question 8

What are the side effects of thiazide type diuretics

Answer 8

Hyponatraemia
Hypokalaemia
Dehydration

Question 9

What are angiotensin II receptor blockers

Answer 9

Block the effects of angiotensin II at the AT1 receptor

End in ‘sartan’

Question 10

What are the side effects of Angiotensin II receptor blockers

Answer 10

Hyperkalaemia

Question 11

What is stage 1 hypertension

Answer 11

Clinic >140/90

ABPM or HBPM >135/85

Question 12

What is stage 2 hypertension

Answer 12

Clinic BP >160/100

ABPM or HBPM >150/95

Question 13

What is severe hypertension

Answer 13

Clinic systolic >180
Clinic diastolic > 120

Question 14

What is the treatment for stage 1 hypertension

Answer 14

Treat if <80 AND: Target organ damage, established cardiovascular disease, renal disease, 10 year cardiovascular risk >10%

If <40 - consider specialist evaluation

Question 15

What should be done for stage 2 hypertension

Answer 15

Treat all patients regardless of age

Question 16

What is first line HTN treatment

Answer 16

Patient <55 years OR type 2 diabetes:

ACE inhibitor OR Angiotensin receptor blocker
(ARB used when ACE is not tolerated)

Patients > 55 or black African or afrocaribbean:

Calcium channel blocker

Question 17

What is second line treatment for HTN

Answer 17

Already taking ACE or ARB - Add CCB or TLD

If already taking CCB - Add ACE, ARB or TLD

Afrocaribbean - If already taking a CCN, consider an ARB next instead of an ACE

Question 18

What is third line treatment for HTN

Answer 18

If already taking ACE and CCB - Add TLD

If already taking Ace and TLD - Add CCB

Question 19

What is fourth line treatment for HTN

Answer 19

step 4 = resistant hypertension.

Tests:
- Confirm HTN
- Assess postural hypotension
- Discuss adherence

If potassium <4.5 - add low dose spironolactone

If potassium > 4.5 - add alpha or beta blocker

Question 20

What is the blood pressure targets

Answer 20

< 80
- Clinic 140/90
- Home 135/85

> 80
- 150/90
- 145/85

Question 21

Who should receive a statin

Answer 21

Anyone with a 10 year cardiovascular risk of >10%

Statins should be taken at night

Question 22

What are common ACE inhibitors

Answer 22

Lisinopril
Captopril
Enalapril
Ramipril
Peridopril
Fosinopril

Question 23

What are examples of ARBs

Answer 23

Candesartan
Azilsartan
Losartan
Eprosartan
Valsartan
Olmesartan

Question 24

What are examples of thiazide like duiretics

Answer 24

Indapamide
Chlortalidone
Xipamide

Question 25

What type of drug is bendroflumethiazide

Answer 25

A thiazide diuretic

Question 26

What are examples of Calcium channel blockers

Answer 26

Dihydropyridine:
Amlodipine
Felodipine
Lacidipine
Nicardipine
Lercanidipine
Nifedipine

Rate limiting:
Verapamil
Diltiazem