Hypertention & ACEi

Question 1

Target BP for those under 80

Answer 1

Clinic:
140/90 mmHg
135/85mmHg

Question 2

Target BP for those with CV disease/high risk

What conditions are included in this?

Answer 2

130/80

Artherosclerotic CV disease, diabetes in presence of kidney, eye or cerebrovascular disease

Question 3

How long is a new antihypertensive used for to establish response

Answer 3

4 weeks

Question 4

Define stage 1 hypertension and when should you treat?
Stage 2?
Severe?

Answer 4

Stage 1 - 140/90mmHg - treat those under 80 who have target-organ damage, CV disease, renal disease , diabetes, 10 year risk over 20%
If under 40 and no target organ damage refer.

Stage 2 - 160/100 - treat all
Severe - 180/110 - treat promptly

Question 5

Treatment steps for patient under 55

Answer 5

ACEi ( if not tolerated ARB or BB)
CCB
thiazide like diuretic
Spironolactone and specialist referral
Alpha blocker

Question 6

Treatments steps for over 55, or black people of any age

Answer 6

CCB ( or if evidence of HF try thiazide like diuretic)
ACEi
Then as with under 55

Question 7

Who should get low dose aspirin

Answer 7

Only those with establish pec CV disease

Question 8

Target BP for over 80 years

Answer 8

150/90

Question 9

Target BP for patients with diabetes

Answer 9

140/80

Question 10

In T1DM hypertension usually indicates ….

Answer 10

Diabetic nephropathy

Question 11

ACEi should be considered for all patients with …… (Sign of renal disease)

Answer 11

Proteinuria

Question 12

Choices for treating hypertension in pregnancy

Answer 12

Labetalol
Mehthyldopa
MR nifedipine

Question 13

Target of BP for pregnancy

• uncomplicated hypertension
• target organ damage

Answer 13

150/100

140/90

Question 14

Risk factors for developing preeclampsia 5

Answer 14

Hypertension
CKD
diabetes
Autoimmune disease
Hypertension in previous pregnancy

Question 15

Women at risk of preeclampsia should take… From when…

Answer 15

Aspirin low dose - from week 12 to term

Also applies for those over 40, over 10 years since last pregnancy, BMI over 35, multiple pregnancy, FH

Question 16

Risks of reducing BP to fast during hypertensive crisis

Answer 16

Reduced organ percussion leading to cerebral infraction, blindness, deterioration in renal function, myocardial ischaemia

Question 17

what class of drugs may be used to treat phaechromocytoma (tumour of the adrenal gland releasing noadrenaline)

Answer 17

alpha blockers such as phenocybenzaine and phentolamine

Question 18

what classes of drugs are doxazoxcin and prazosin

Answer 18

alpha blockers (and vasodilators)

Question 19

what class of drug is hydralazine and why do we not often use it

Answer 19

alphablocker

used as an adjunt in hypertensive treatment but causes tachycardia and fluid retention when used alon

Question 20

when is methyl dopa used as an antihypertensive

Answer 20

pregnancy

it is a centrally acting antihypertensive

Question 21

why is clonidine not often used

Answer 21

centrally acting antihypertensive but causes rebound hypertension on withdrawl

Question 22

what is the mode of action of alfuzosin, terazocin and tamsulosin
what are they used for

Answer 22

alpha blockers for BPH

Question 23

when starting ACEi what electrolyte discturbance should first be addressed

Answer 23

-stop K supplements and K sparing diuretics as ACEi may cause hyperkalaemia

Question 24

what is a caution when introducing an ACEi to a patient already taking a high dose of loop diuretic in HF?
what is classed as high dose

Answer 24

profound first dose hypertension
(temporary withdrawl of the loop may reduce risk but conversely cause pulmonary oedema)

furosemide 80mg OD

Question 25

ACEi have a role in managing what side effect of diabetes

Answer 25

nephropathy

Question 26

why should ACEi not be given with NSAIDs

Answer 26

increased risk of renal damage

Question 27

what renal condition should we never used ACEi/ARB in?

Answer 27

renal artery stenosis {bilateral or severe unilateral} (ACEi would reduce glomerular filtration causing failure)
- also caution ACEi in peripheral vascular disease

Question 28

what to change ACEi to if patient experiences dry cough?

why does this help?

Answer 28

ARB

they don’t inhibit breakdown of bradykinin (bradykinin causes the cough(

Question 29

why should you not use more than one drug affecting the renin angiotensin system

Answer 29

increased risk of hyperkalaemia, hypotension and renal impairment

Question 30

why should afro-carribean pt not receive ACEi? (2)

Answer 30

less likely to respond (as likely to have low rennin hypertension)
more likely to develop angioedema

Question 31

what should you do with ACEi pt develops altered LFTs

Answer 31

stop ACEi - reports of cholestatic jaundice, hepatitis, hepatic necrosis etc.

Question 32

what time of day should the first dose of ACEi be given

Answer 32

bedtime

Question 33

what is aliskiren?

Answer 33

renin inhibitor

Question 34

if someone has HF what antihypertensive are we thinking about first line

Answer 34

thiazide like diuretic

Question 35

if a pt has a STEMI how fast should there BP be reduced

Answer 35

reduce over period of 2 mins to 2 hours by 20-25%

Question 36

mode of action of sildenafil

Answer 36

vasodilator

Question 37

mode of action of iloprost

Answer 37

vasodilator

Question 38

mode of action of doxasosin

Answer 38

alpha blocker

Question 39

mode of action of methyldopa

Answer 39

centrally acting

Question 40

mode of action of guanethidine monosulfate

Answer 40

adrenergic neurone blocker

Question 41

mode of action of aliskiren

Answer 41

renin inhibitor (so probs dont give with ACE/ARBs!)

Question 42

how fast do ACEi reduce BP

Answer 42

2 hours