Management of hypertension

Question 1

in most patients with hypertension, what is the target blood pressure to aim for?

Answer 1

140/90mmHg and if tolerated 130/80mmHg or lower in most patines

Question 2

in people over age of 65 and diabetes, what is the target blood pressure to aim fo?

Answer 2

= 140-130mmHg but NOT < 120mmHg

Question 3

in very old people, what is the target blood pressure to aim for?

Answer 3

= 140-130mmHg but NOT< 130mmHg

Question 4

when should alcohol reduction be recommended for prevention & treatment of hypertension?

Answer 4

amongst heavy drinkers

Question 5

for every kilogram of weight lost, how much does this Lower the blood pressure?

Answer 5

1mmHg is lots for every kg

Question 6

if you have a no salt added diet, how does this reduce blood pressure?

Answer 6

reduces BP by 2-4mmHg

Question 7

reduction in what ion may also reduce long term risk of CV events?

Answer 7

long term sodium reduction

Question 8

what activity reduces blood pressure 3.8/2.6mmHg?

Answer 8

aerobic exercise

Question 9

what is the relationship between proportional risk reduction and absolute level of risk factor?

Answer 9

proportional risk reduction is INDEPENDENT of the absolute level of the risk factor

Question 10

true or false.

everybody is hypertensive & dyslipidaemic.

Answer 10

True

Question 11

what is the main benefit of anti-hypertensive therapies due to?

Answer 11

due to BP lowering

Question 12

name 5 generic BP drugs?

Answer 12

1) thiazide diuretics
2) ACE inhibitors/ARBs
3) calcium channel blockers
4) beta blockers
5) spironolactone, alpha blockers, centrally acting, older drugs

Question 13

what are 5 targeted BP drugs?

Answer 13

1) B blockers (Ca blockers) in angina
2) ACEI & B blockers in CCF
3) ACEI/ARBs in diabetic nephropathy
4) Alpha blockers in prostatism
5) thiazide in elderly
6) others

Question 14

in people under age of 55 what is the first step treatment should they be given?

Answer 14

A
= ACE inhibitor
OR
= low cost angiotensin II receptor blocker (ARB)

Question 15

in people over age of 55 or black person of African or Caribbean family origin what is the first step should be given?

Answer 15

C

= calcium channel blockers (CCB)

Question 16

what is the step 2 in treatment for hypersensitive patients?

Answer 16

A + C
= ACE inhibitor or low cost angiotensin II receptor blockers
AND
= calcium channel blocker

Question 17

what is step 3 in treatment.for hypersensitive patients?

Answer 17

A + C + D 
= ACE inhibitor or low cost angiotensin II receptor blockers 
AND 
= calcium channel blocker 
AND 
= thiazide like diuretics

Question 18

what is step 4 also known as?

Answer 18

resistant hypertension

Question 19

what needs to be done in steps 4?

Answer 19

= ACE inhibitor or low cost angiotensin II receptor blockers 
AND 
= calcium channel blocker 
AND 
= thiazide like diuretics 

+ further diuretic or alpha or beta blocker

Question 20

what is one of the main consequences of using a diuretic?

Answer 20

low potassium levels = hyperkalaemia

Question 21

if diuretics still need to be used, what should also be given to avoid potassium levels getting to 4.5mmol/l lower?

Answer 21

= low dose spironolactone (25mg once daily)

Question 22

if at step 4, further diuretics are not tolerated, what could be used?

Answer 22

an alpha or beta blocker.

Question 23

how many more times effective is adding a drug than titrating?

Answer 23

5x more effective

Question 24

true or false.

Starting with two drugs is always better than starting with one.

Answer 24

True

Question 25

True or false.

Combination therapy has fewer side effects than mono-therapy.

Answer 25

true.

Question 26

what are 7 things associated with resistant hypertension?

Answer 26

1) non-concordance
2) white coat effect
3) pseudo-hypertension
4) lifestyle factors
5) drug interactions
6) secondary hypertension
7) true resistance

Question 27

what drug is most effective at treating resistant hypertension?

Answer 27

= spironolactone

Question 28

when should patients only be defined as resistant hypertension?

Answer 28

unless their BP remains uncontrolled on spironolactone.

Question 29

what 2 groups of people should take spironolactone with caution?

Answer 29

1) diabetes

2) low GFR

Question 30

in summary what drugs are available for people under 55?

Answer 30

- ACE/ARB 
or
- B-blocker if fertile female 
- calcium antagonista 
- diuretic 
- spironolactone

Question 31

inn summary what drugs are available for people over 55?

Answer 31

• calcium antagonists
• ACE/ARB
• diuretics
• spironolactone

Question 32

what are the 6 examples of hypertensive drugs that could be used?

Answer 32

1) diuretics
2) calcium channel blockers
3) angiotensin receptor antagonnists
4) alpha adrenoceptor antagonistts
5) beta adrenoceptor antagonists
6) ACE inhibitor

Question 33

give an example of a thiazide diuretic.

and the side effects of them.

Answer 33

Example
= bendrofluazide

Side effects
= hypokalaemia
= hyperglycaemia
= hyperuricaemia

Question 34

give an example of beta adrenoceptor antagonist.

and the side effects of them.

Answer 34

Example;
= atenolol

Side effects;
= donut use in asthma
= tired, cold peripheries

Question 35

give an example of calcium channel blockers.

and the side effects of them.

Answer 35

Example;
= amiodipine

Side effects;
= ankleoedema

Question 36

give an example of an alpha adrenoceptor antagonist.

and the side effects of them.

Answer 36

Example;
= doxazosin or prazosin

Side effects;
= postural hypotension

Question 37

give an example of an ACE inhibitor.

and the side effects of them.

Answer 37

Example;
= lisinnopril

Side effects;
= large decreases in BP hypertensive patients.
= hypotension in patients treated.
DON’T GIVE IN PREGNANNCY

Question 38

give an example of an angiotensin receptor antagonist.

and the side effects of the.

Answer 38

example ;
= losartan

Side effects;
= DON’T GIVE IN PREGNANCY
- bilateral renal artery stenosis