L97- Introduction to the management of hypertension

Question 1

what are the 8 drugs groups are used to treat hypertension?

Answer 1

• Diuretics
• Angiotensin converting enzyme inhibitors (ACEI’s)
• Angiotensin-II receptor antagonists (ARBs)
• Calcium channel blockers (CCB
• Beta-blockers
• Alpha- blockers
• Centrally acting agents
• Renin inhibitors

Question 2

what 7 factors affect the choice of drug used to treat hypertension?

Answer 2

• cost
• side effects
• ability to reduce bp
• adherence
• ability to reduce complications
• patient characteristics
• other medical conditions

Question 3

how does “reduce complication” affect what drugs a patient trying to reduce bp will take?

Answer 3

-reduce myocardial infarction, stroke, heart failure

Question 4

how does “patient characteristics” affect what drugs a patient trying to reduce bp will take?

Answer 4

• age
• ethnicity
• pregnancy
• allergies

Question 5

how does “other medical conditions” affect what drugs a patient trying to reduce bp will take?

Answer 5

• specific drug for HT may have added benefits for other diseases e.g. diabetes
• Drug of choice for HT may be contraindicated e.g. asthma

Question 6

how does “side effects” affect what drugs a patient trying to reduce bp will take?

Answer 6

• some are predictable
• some are unpredictable
• some may cause problems in high risk patients

Question 7

how does “adherence” affect what drugs a patient trying to reduce bp will take?

Answer 7

• -dose frequency, better once a day

- side effect profile e.g urinary frequency with diuretics

Question 8

what does “cost” affect what drugs a patient trying to reduce bp will take?

Answer 8

• where its a generic name or branded

- if its a new drug or not

Question 9

what percentage of people have to take more than one HT drug?

Answer 9

75%

Question 10

why is using combines drugs to treat HT alright?

Answer 10

they have different pharmacology/mechanisms of action/act on different pathways

Question 11

what drug groups are used to treat HT?

Answer 11

• calcium channel blockers
• Angiotensin converting enzyme inhibitors (ACEIs)
• Diuretics
• Angiotensin II receptor blockers (ARBs)
• Beta-blockers
• alpha-blockers
• renin inhibitors
• centrally acting agents

Question 12

what group of people will be given Angiotensin converting enzyme inhibitors (ACEIs)?

Answer 12

• e.g ramipril-first line in all patients who are diabetics, also prevents renal disease caused by diabetes
• first line in patients under 55 years.
• can cause a dry cough

Question 13

what patients are given diuretics to treat HT?

Answer 13

thiazides- used in combination with other
antihypertensives (Step 2 & 3 NICE 2019) and lower potassium levels
Aldosterone antagonists- first line to treat heart failure

Question 14

what group of patients would use beta-blockers? example

Answer 14

example atenolol

• NOT asthmatics
• first line for people who are pregnant
• used to treat heart failure

Question 15

what group of patients would use centrally acting agents?

Answer 15

pregnant women

Question 16

what are some facts and an example about renin inhibitors?

Answer 16

example= aliskirin

• evidence about them is limited
• they are expensive
• used for patients that are resistant HT

Question 17

what are some facts and an example about centrally acting agents?

Answer 17

example= methyldopa and clonidine

• reserved for resistant HT
• significant side effects
• methyldopa used in pregnancy

Question 18

what group of patients will be given calcium channel blockers as first line?

Answer 18

patients over 55 years old and black African Caribbean patients of any age

Question 19

what are the two types of diuretics?

Answer 19

• thiazides

- aldosterone antagonists

Question 20

what are some facts about he two different types of diuretics?

Answer 20

• thiazides- can cause low potassium levels and doesn’t work with patients who have had renal failure
• aldosterone antagonists-can cause high potassium levels and used to treat heart failure

Question 21

what are Angiotensin II receptor blockers (ARBs) and give an example?

Answer 21

losartan- Alternative to ACEIs (especially when

patients develop dry cough)