Hypertension Management

Question 1

Target clinic BP/ABPM in < 80 y/o

Answer 1

<140/90

ABPM < 135/85

Question 2

Target clinic BP and ABPM in > 80 y/o

Answer 2

<150/90

ABPM < 145/85

Question 3

Target clinic BP and ABPM in diabetics

Answer 3

< 130/80

ABPM < 125/80

Question 4

What advice would you give to a pt with HTN?

Answer 4

Low salt diet < 6g/day
Low fat diet
Reduce caffeine intake
Stop smoking
Drink less alcohol
Balanced diet with fruit and vegetables
Exercise 
Reduce weight if obese

Question 5

Which patients should be treated?

Answer 5

ABPM 150/95 –> treat
ABPM 135/85, < 80 years and target organ damage (retina/kidney/brain/heart), estabolished CVS/renal disease, DM, 10 yr CVS risk 20% –> treat

Question 6

Describe the treatment pathway for hypertension if < 55 years

Answer 6

1. ACE inhibitor - ramipril
   If not tolerating - ARB - losartan
2. ACE inhibitor + CCB
3. ACE inhibitor + CCB + thiazide diuretic (chlorthalidone/indapamide)
4. THEN
   If K 4.5 or less, add spironolactone
   If K is over 4.5 add higher dose thiazide like treatment
   If further diuretic therapy not tolerated/ineffective - consider alpha/beta blocker

Question 7

Describe the treatment pathway for hypertension if 55 years +

Answer 7

1. CCB
2. ACE inhibitor + CCB
3. ACE inhibitor + CCB + thiazide diuretic (chlorthalidone/indapamide)
4. THEN
   If K 4.5 or less, add spironolactone
   If K is over 4.5 add higher dose thiazide like treatment
   If further diuretic therapy not tolerated/ineffective - consider alpha/beta blocker - bisorolol

Question 8

Describe treatment pathway if afro-Caribbean origin

Answer 8

1. CCB
2. ACE inhibitor + CCB
3. ACE inhibitor + CCB + thiazide diuretic (chlorthalidone/indapamide)
4. THEN
   If K 4.5 or less, add spironolactone
   If K is over 4.5 add higher dose thiazide like treatment
   If further diuretic therapy not tolerated/ineffective - consider alpha/beta blocker

Question 9

What are side effects of ACE-i? CI?

Answer 9

SE: cough due to bradykinin build up
Hyperkalaemia
Renal failure
Angio-oedema

CI: bilateral renal artery or aortic valve stenosis

Question 10

What are SE of Calcium channel antagonists?

Answer 10

SE: flushes, fatigue, gum hyperplasia, ankle oedema

Question 11

What are SE/ CI of thiazides?

Answer 11

Hypokalaemia
Hyponatraemia
CI: Gout

Question 12

What are side effects of ARB?

Answer 12

Vertigo, urticaria, pruritus

Question 13

What are SE of beta blocker

Answer 13

bronchospasm
heart failure
cold peripheries
lethargy
impotence

CI - asthma, caution in heart failure