pharmacological treatment of hypertension

Question 1

what are three different ways of calculating cardiovascular risk?

Answer 1

ASSIGN
Qrisk
JBS3

Question 2

when would anti-hypertensive drugs be indicated with stage 1 hypertension?

Answer 2

if the patient is younger than 40
if there is target organ damage
10-year cardiovascular is greater than 20%
diabetes
renal disease

Question 3

what are the three main goals of anti-hypertensive treatment?

Answer 3

• reduce arterial blood pressure to recommended targets

- reduce risk of end organ damage (cardiovascular, renal, cerebrovascular)

Question 4

what is the target blood pressure for patients aged over 80?

Answer 4

less than 150/90 mmHg

Question 5

what is the target blood pressure for standard patients?

Answer 5

less than 140/90

Question 6

what is the target blood pressure for patients with cardiac or renal disease or diabetes?

Answer 6

less than 130/80

Question 7

what is the first step if the patient is under 55 years old and of caucasian origin?

Answer 7

A - ACE inhibitor or low cost angiotensin 2 receptor blocker (ARB)

Question 8

what is the first step of treatment if the patient is over 55, black or of afro-carribean origin?

Answer 8

C - calcium channel blocker

Question 9

what is the second step of treatment for all patients?

Answer 9

add either A (ACE inhibitor or ARB) or C (calcium channel blocker)

Question 10

what is the third step of treatment for all patients?

Answer 10

D - thiazide like diuretic

Question 11

what is the final step of treatment for RESISTANT HYPERTENSION?

Answer 11

consider further diuretic (spirolone or furosemide for patients with moderate-severe renal impairment)
alpha or beta blocker

Question 12

what are the two main types of angiotensin converting enzyme inhibitors?

Answer 12

ramipril and lisinopril

Question 13

what is a the one ARB?

Answer 13

Iosartan

Question 14

what are the three dihydropyridine derived calcium channel blockers?

Answer 14

amlodipine
lercanidipine
felodipine

Question 15

what are the two thiazide-like diuretics?

Answer 15

indapamide

bendroflumethiazide

Question 16

what is the aldosterone antagonist diuretic?

Answer 16

spironolactone

Question 17

where about in the kidney nephron do thiazine-like diuretics prevent sodium reabsorption?

Answer 17

in the distal tubule

Question 18

where about do the aldosterone antagonist diuretics prevent sodium reabsorption?

Answer 18

in the collecting duct

Question 19

what are some advantages of multi drug treatment?

Answer 19

• each drug is working at a different site in the body

- reduces dose burden

Question 20

what are some disadvantages of multi drug treatment?

Answer 20

side-effects may be more frequent

increased drug cost to NHS