Hypertension - treatment

Question 1

What is used in step 1 treatment in those aged under 55yo/high renin hypertension?

Answer 1

Angiotensin converting enzyme inhibitors
Angiotensin II antagonists

Suitable for those with high renin hypertension

Question 2

What is used in step 1 treatment in those over 55yo or of afro-caribbean origin/low renin hypertension?

Answer 2

Calcium channel blockers
Thiazide type diuretics

Suitable for those who have low renin hypertension

Question 3

Name some ACE inhibitors

Answer 3

Ramipril

Perindopril

Question 4

When might calcium channel blockers be unsuitable?

Answer 4

Oedema
Intolerance
Evidence or high risk of HF

Question 5

When might ACEI/ARBs be unsuitable?

Answer 5

Teratogenic - do not use in young women of child bearing age

Question 6

Describe some contraindications when using ACEIs

Answer 6

Renal artery stenosis
Renal failure
Hyperkalaemia

Question 7

Whats are some ADRs when using ACEIs?

Answer 7

Cough!
First dose hypotension
Taste disturbance
Renal impairment
Angioneurotic oedema

Question 8

What DDIs must you be wary of when using ACEIs?

Answer 8

NSAIDs
Potassium supplements
Potassium sparing diuretics

Question 9

Name some angiotensin II antagonists (ARBs)

Answer 9

Valsartan
Losartan
Candesartan
Irbesartan

Question 10

Give one advantage and one disadvantage when using ARBs over ACEIs

Answer 10

No cough and fewer side effects

Not as effective at preventing secondary MIs and strokes

Question 11

Give some examples of both rate limiting and vasodilator calcium channel blockers

Answer 11

Vasodilators - amlodipine, felodipine

Rate limiting - verapamil, diltiazem

Question 12

What do CCBs block?

Answer 12

L-type calcium channels

Question 13

Name some contraindications when using CCBs

Answer 13

Acute MI
HF
Bradycardia (when using rate limiting)

Question 14

Name some ADRs to watch out for when using CCBs

Answer 14

Flushing
Headache
Ankle oedema
Indigestion
Reflux oesophagitis

Question 15

Name two side effects specific to rate limiting CCBs

Answer 15

Bradycardia

Constipation

Question 16

Name some thiazide type diuretics

Answer 16

Indapamide

Clortalidone

Question 17

Describe briefly the mechanism of action of thiazide type diuretics

Answer 17

Block Na reabsorption, enhancing urinary sodium loss

Question 18

What are some ADRs associated with thiazide type diuretics?

Answer 18

Gout

Impotence, particularly in men

Question 19

Name 3 classes of less commonly used anti-hypertensives

Answer 19

Alpha-adrenoreceptor antagonists
Centrally acting agents
Vasodilators

Question 20

Name an alpha-adrenoreceptor antagonist

Answer 20

Doxazosin

Question 21

Name some ADRs associated with alpha-adrenoreceptor antagonists

Answer 21

Dry mouth
First dose hypotension
Dizziness
Headaches

Question 22

Describe the mechanism of action of methyldopa for hypertension

Answer 22

Converted to a-methylnoradrenaline, which acts on CNS a-adrenoceptors to decrease central sympathetic outflow

Question 23

Describe some ADRs associated with methyldopa

Answer 23

Dry mouth
Nasal congestion
Sedation and drowsiness
Orthostatic hypotension

Question 24

What type of drug is moxonidine?

Answer 24

Centrally acting imidazoline agonist. These receptors are found in the medulla oblongata, and cause a decrease in sympathetic nervous system activity and, therefore, a decrease in blood pressure.

Question 25

Roughly how many women with hypertension develop pre-eclampsia when pregnant?

Answer 25

1/3

Question 26

What proportion of women who develop pre-eclampsia develop CVD events?

Answer 26

1/2

Question 27

How do we differentiate between gestational hypertension and pre-eclampsia

Answer 27

Gestational hypertension - BP rises but no proteinuria

Pre-eclampsia - BP rises severely from about 20 weeks >140/90mmHg with proteinuria

Question 28

Define proteinuria

Answer 28

Protein >300mg/24hr