Pharmacological treatment of hypertension

Question 1

What do the chances of harm due to high blood pressure depend on?

Answer 1

• How high BP is
• How long they’ve had high BP
• Other health problems
• Concordance with medication

Question 2

What can untreated hypertension lead to?

Answer 2

vascular and renal damage; resulting in a treatment resistant state

Question 3

Goals of the treatment of hypertension

Answer 3

• Reduce BP to recommened targets
• Reduce risk of end organ damage (CVS, renal, cerebrovascular)
• Reduce risk of mortality

Question 4

In what situations are anti-hypertensive drugs indicated?

Answer 4

1. People have stage 2/3 hypertension
2. People with stage 1 hypertension and one more of the following:

• Target organ damage
• Cardiovascular disease
• Renal disease
• Diabetes
• A 10 year cardiovascular sik equivalent to 10% greater

3. Use clinical judgement for people of any age with fraility or multimorbidity

Question 5

What is estimation of CV risk based on?

Answer 5

• BP
• Age
• Weight/height
• gender
• smoking
• cholestrol
• ethnicty
• social class
• family history
• diabetes, rheumatoid arthritis, renal function

Question 6

What drugs can increase BP before starting anti-hypertensive drugs?

Answer 6

• NSAIDs
• Oral steroids
• Venlafaxine (anti-depressant)
• Oral sympathomimetic decongestants
• Soluble or dispersible drugs
• Illict drug use

Question 7

What tests are used to confirm high blood pressure?

Answer 7

• ABPM
• ECG
• Blood tests

Question 8

What is the order for prescribing antihypertensive drugs

Answer 8

ACDC

A - ACE I or ARB

C - Calcium channel blocker

D - diruetic (thiazide)

C - Call for help

Question 9

Give examples of ACE inhibitors

Answer 9

Ramipril, lisinpril, captopril

Question 10

Give examples of ARBs

Answer 10

Losartan, candesartan, ibresartan

Question 11

Give examples of calcium channel blockers

Answer 11

Amlodipine, felodipine, lercanidpine

Question 12

Give examples of thiazide like diruetics

Answer 12

Indapamide, bendoflumethazide

Question 13

What is precribed when K⁺ conc > 4.5mmol/L?

Answer 13

Sympathetic NS antagonist - Beta blockers and alpha1 adrenoreceptor blockers (result in vasodilation)

Question 14

What kidney function modifiers are precribed if K⁺ conc <4.6mmol/L

Answer 14

Potassium soaring diruetic and aldosterone antagonists

Amiloride, spironolactone

Question 15

Action of renin angiotensin system inhibitors

Answer 15

ACE - inhibit the angiotensin converting enzyme

ARB - block the receptors

Question 16

Action of calcium channel blockers

Answer 16

block the entry of calcium through slow channels in cardiac and smooth muscle

Greater impact on vascular smooth muscles, reduces PR, less effective on myocardium

Question 17

Action of thiazide diruetics

Answer 17

• inhibit sodium reabsorption in nephron
• reduce sodium and water retention
• increased diuresis
• reduced blood volume
• reduce BP

Question 18

Pros of multi-drug treatment in hypertension

Answer 18

• Reduced mortality/morbidity
• Each drug class working at different sites in the body
• Can achieve BP targets more quickly
• Reduces dose burden of each drug so minimising side effects

Question 19

What are the cons of multi-drug treatment of hypertension?

Answer 19

• Concordance problem
• Increased drug cost
• Side effects may be more frequent