Management of CV Risk Factors ☺️

Question 1

Hypertension

• presentation
• investigation
• diagnosis

Answer 1

Asymptomatic
Severe - dizzy, headache, nosebleeds
1st presentation -stroke, MI

CBPM 2x - 140/90+
-if both measurements v different => 3rd measurement and record lower of last 2
ABPM/HBPM to confirm - 135/85+
-if Stage 3 => no confirmation needed

Investigate 2ndary causes in U40s

Question 2

Hypertension management

-Stage 1

Answer 2

ABPM/HBPM - 135/85+

Lifestyle advice

• healthy diet, increased physical activity
• lower BMI
• low salt
• smoking cessation
• reduce alcohol

Question 3

Hypertension management

• Stage 2
• U55, diabetic
• 55+, black

Answer 3

Lifestyle advice + drug

U55, diabetic
1st line - A drug, swap with other if first not effective
2nd line - add C
3rd line - A+C+D

55+, black
1st line - C (or Dt if CI)
2nd line - add A/D
3rd line - A+C+D

4th line =>

• spirololactone if K U4.5
• Ab/Bb if K 4.5+

5th line => specialist advice

Question 4

Hypertension management

-Stage 3

Answer 4

Target organ damage
Yes => drug treatment
No => repeat CBPM in 1wk

Refer for same day specialist review if

• retinal bleed/papillodema
• life threatening symptoms (new onset chest pain, heart failure, AKI
• pheochromocytoma?

Question 5

BP targets for

• U80
• 80+

Answer 5

U80

• CBPM - U140/90
• ABPM/HBPM - U135/85

80+

• CBPM - U150/90
• ABPM/HBPM - U145/85

Use ABPM/HBPM if significant white-coat effect

Question 6

ACEi, ARB, Bb, CCB, Diuretics

• MOI
• SE
• CI

Answer 6

ACEi - inh Ang2 formation
SE - dry cough, renal impairment, angioedema
CI - renal impariment, pregnancy

ARB - inh Ang2
SE - fewer than ACEi
CI - renal impairment, pregnancy

Bb - good for HF, angina, MI
SE - fatigue, cold hands
CI - asthma, COPD, poor arterial circulation

CCB - arterial VD, good for circulatory problems, angina
SE - ankle swelling, headache, flushing, constipation

Diuretics - reduce BV
SE - increased urination, ED, hypoNa, K, gout

Question 7

QRISK interpretation

• U10%
• 10%+

Answer 7

U10%

• lifestyle advice
• comorbidity optimisation (HTN, DM)

10%+
-Add atorvastatin 20mg daily

Question 8

Lipid modification

-investigations

Answer 8

Non fasting lipid profile

• total cholesterol
• Non HDL, HDL, LDL, TAG

LFT
eGFR, U&E
HbA1c

Exclude secondary causes of dislipidemia
-alcohol, poor diabetic control, hypothyroidism, liver disease, nephrotic

Question 9

When to suspect familial hypercholesterolemia

• clinical diagnosis
• management

Answer 9

AD

• homozygous more severe
• FHx CHD

Clinical diagnosis

• TC 7.5+ and LDL 4.9+
• physical signs (tendon xanthomata)

Refer to lipid clinic, screen 1st degree relatives

1st line - high dose statin/ezetimibe
2nd line - lipid apheresis
3rd line - liver transplantation

Question 10

Lipid management

• 1ary prevention of CV events
• 2ndary prevention of CV events

Answer 10

1ary prevention
Lifestyle advice
1st line - atorvastatin 20mg OD (inh HMGCoaReductase)
SE - myalgia
CI - pregnancy
2nd line - ezetimibe (inh dietary cholesterol uptake)

2ndary prevention
Same as 1ary but 80mg

Question 11

DM - management

Answer 11

Assess HbA1c - optimise glucose control under 48mmol/6.5%

Question 12

Investigations for target organ damage

Answer 12

Heart - 12lead ECG, cholesterol, HbA1C
Brain, eyes - papilloedema
Kidney - albumin:creatinine ratio, urine dipstick, eGFR