Lecture 8: Pharmaceutical care in hypertension

Question 1

What is the definition of hypertension?

Answer 1

A condition where blood pressure is elevated to an extent where clinical benefit is obtained from blood pressure lowering

Question 2

What is the presentation of hypertension?

Answer 2

• Usually asymptomatic
• Often an incidental finding or found through screening

Question 3

What is the target blood pressure?

Answer 3

<140/<90 mmHg

Question 4

What is the target blood pressure in diabetic patients with complications and existing CVD

Answer 4

<130/<80 mmHg

Question 5

What is non-pharmacolgical mangement of hypertension

Answer 5

• Weight
• Smoking
• Exercise
• Salt
• Alcohol
• Diet

Question 6

What are the different classes of blood pressure?

Answer 6

• Optimal
• Normal
• High normal
• Grade 1 hypertension
• Grade 2 hypertension
• Grade 3 hypertension
• Isolated systolic hypertension

Question 7

What is optimal blood pressure?

Answer 7

<120/<80

Question 8

What is normal blood pressure?

Answer 8

<130/ <85

Question 9

What is high-normal blood pressure?

Answer 9

130/139/ 85/89

Question 10

What is grade I hypertension?

Answer 10

140-159/ 90-99

Question 11

What is grade II hypertension?

Answer 11

160/179/ 100-109

Question 12

What is grade III hypertension?

Answer 12

> 180 / >110

Question 13

What is grade I isolated systolic hypertension?

Answer 13

140-159/ <90

Question 14

What is grade II isolated systolic hypertension?

Answer 14

> 160 / <90

Question 15

What are the therapeutic options for managing hypertension?

Answer 15

• ACE inhibitors/ ARB
• Beta blockers
• Calcium channel blockers
• Diuretcs
• Others ( Alpha blockers, vasodilators, cenrally acting agent

Question 16

What is the AB/CD rule?

Answer 16

• White and < 55 years; high renin (ACE inhibitor/ ARB)
• Afro carribean nd >55 years; low renin (CCB or diuretic)
• Combine from other group eg A+C or D
• Thereafter add alpha-blocker or spironolactone or Beta blocker

Question 17

When can you consider a beta blocker?

Answer 17

White and <55 years as an alternative to A

Question 18

What are beta blockers linked to the development of?

Answer 18

Diabetes

Question 19

What should beta blockers not be combined with?

Answer 19

Diuretics

Question 20

Name hypertension exacerbating drugs (5)

Answer 20

• NSAIDS
• Oestrogens
• Sympathomimetics
• Corticosteroids and other fluid retaining drugs
• Medicines with a high sodium content

Question 21

What are the key risk factors for CVD?

Answer 21

• Coronary heart disease
• Stroke
• Heart failure
• Renal failure
• Retinopathy
• Vascular dementia

Question 22

How do you manage grade 3 hypertension?

Answer 22

Refer

Question 23

What may be the cause of hypertension

Answer 23

1. Malfunction in sympathetic drive
2. Malfunction in RAAS
3. Inflammatory process in the endothelial

Question 24

What is first line treatment for a white patient younger than 55?

Answer 24

ACE inhibitor or Angiotensin receptor blocker

Question 25

What can bradykinin cause?

Answer 25

Irritates the throat - dry cough

Question 26

What can ACE inhibitors cause?

Answer 26

Dry cough