Managing Hypertension

Question 1

What primary prevention tool used in the clinic is for CVD? Briefly Discuss it

Answer 1

Qrisk3 which predicts the individual’s 10-year CVD risk.

This is a program that incorporates RF of CVD to predict this. This includes age, sex, smoking, diabetes, angina, cholesterol, SBP, and treatments

Question 2

What medication would you prescribe to a patient suffering from postural hypotension?

What type of medication is it?

Answer 2

Midodrine (vasopressor)

Question 3

What are the 3 stages of HTN

Answer 3

Stage 1 - 140/90
Stage 2 - 160/90
Stage 3 - 180/110

Question 4

What is the treatment ladder for HTN

Answer 4

Step 1:
<55 - ACEi/ARBs
>55/afrocarribean - CCB/Thiazide-like diuretic

Step 2: ACEi(or ARBs) + CCB (or Thiazide-like diuretic)

Step 3: Ensure step 2 adherence and concordance. If good, then give ACEi (or ARBs) + CCB + Thiazide-like

Step 4: Consider adding Spironolactone and if not Beta blocker.

Below is just something to recall and help with lifestyle changes

2) RF reduction:
- Smoking cessation
- Reduce weight (5-10%)
- Regular exercise (150 moderate, 75 high)
- Reduce alcohol intake (<14)
- Reduce salt intake (<6g/day)
- Reduce caffeine intake
- Mediterranean diet: Increase fruit and veg intake (>5/day), fish >2/week
- Relaxation and stress management