Management

Question 1

What is the management for a hypertensive emergency?

Answer 1

• IV medication (fast) - relax arteries - vasodilator, Ca channel blocker, beta blocker
• Intensive care unit

Question 2

What is the Qrisk threshold for?

Answer 2

When considering lipid modification threshold, NICE determines the threshold for primary prevention of CVD risk is 10%.

Question 3

What medication is used in a hypertensive emergency?

Answer 3

IV nitroglycerine (peripheral vasodilator)
Preferred treatment for patients with co-existent coronary ischaemia and congestive cardiac failure.

Question 4

What is adrenaline used for clinically?

Answer 4

Anaphylactic shock, cardiogenic shock, cardiac arrest

Question 5

What is noradrenaline used for clinically?

Answer 5

Severe hypotension and septic shock

Question 6

What is the treatment for Addison’s disease?

Answer 6

• Glucocorticoid and mineralocorticoids
• Acutely ill > hydrocortisone IV

Question 7

What lifestyle factors should be managed for hypertension?

Answer 7

• Diet
• Salt
• Caffeine
• Smoking
• Alcohol
• Regular exercise

Question 8

What is the monotherapy for hypertension?

Answer 8

• If >55yrs and in black patients 1st choice is Ca channel antagonist or thiazide
• If <55 or have T2DM, 1st choice is ACEi or ARB (if ACEi intolerant e.g.cough)
• Beta blockers not first line but consider in young people if contraindication to ACEi/ARB, child-bearing potential or increased sympathetic drive

Question 9

What is the combination therapy for hypertension?

Answer 9

• Current recommendation is ACEi, Ca channel antagonist and thiazide
• If BP still uncontrolled consider added spironolactone or higher dose thiazide - monitor U+E
• Alternatively beta blocker or alpha blocker

Question 10

How do ACEi potentially cause kidney damage?

Answer 10

ACEi deactivate the RAAS system which helps systemic hypertension but stop vasoconstriction of efferent arteriole causing a drop in GFR. If bilateral renal artery stenosis is present this can cause severe renal failure. This means U+E’s must be done a few days after starting ACEi.