S4.2 Treatment for Hypertension and Heart Failure

Question 1

What are the different grades of hypertension?

Answer 1

Grade 1 - 140/90 mmHg
Grade 2 - 160/100 mmHg
Grade 3 - >180/110 mmHg

Question 2

What is the difference between primary and secondary hypertension?

Answer 2

Primary - no known cause, but causative agents include the pill and high alcohol
Secondary - discrete, identifiable cause

Question 3

What is the mechanism of ACEi?

Answer 3

Eg lisinopril, ramipril
Stop Ang1 to Ang2 conversion, causing less vasoconstriction, Na retention and aldosterone release.
Also increases bradykinin (vasodilator)

Question 4

What are the ADRs of ACEi?

Answer 4

Cough
Angio-oedema
Renal failure
Hyperkalaemia

Question 5

What is the mechanism of angiotensin receptor blockers?

Answer 5

Eg losartan, candesartan

Bind to Ang1 receptor preventing Ang2 formation, so no vasoconstriction or aldosterone release.

Question 6

What are the ADRs of ARB?

Answer 6

Renal failure

Hyperkalaemia

Question 7

What is the mechanism of Ca channel blockers?

Answer 7

Bind to specific alpha subunit of L-type calcium channel, reducing cellular calcium entry.
Vasodilates peripheral, coronary and pulmonary arteries

Question 8

What are the three groups of Ca channel blockers? Give examples also

Answer 8

Dihydropyridines - amlodipine
Phenylalkylamines - verapamil
Benzothiazapines - diltiazam

Question 9

What are the ADRs of amlodipine?

Answer 9

Tachycardia, sweating, oedema

Question 10

What is the mechanism and ADRs of verapamil?

Answer 10

Causes vasodilation and reduces myocardial contractility.

ADRs – constipation and bradycardia

Question 11

What is the mechanism and ADRs of diltiazam?

Answer 11

Causes vasodilation and reduces myocardial contractility.

ADRs – bradycardia and slight negative inotropy.

Question 12

How do thiazide diuretics reduce bp?

Answer 12

Block NaCl in the distal tubule, this reduces Na reabsorption, reducing blood volume.

Question 13

What are the NICE guidelines for a patient with high bp?

Answer 13

Younger than 55 - give ACEi
Black or >55 - give CCB
If still no improvement give both, then add diuretics

Question 14

Summarise the features of alpha blockers?

Answer 14

Eg doxazosin
Mechanism: Act via selective antagonism at post-synaptic α1 adrenoceptors, and antagonise the contractile effects of noradrenaline on vascular smooth muscle so reducing TPR
ADRs: postural hypotension

Question 15

Summarise the features of beta blockers

Answer 15

Eg propranolol, labetalol
Mechanism: Antagonise the action of β1-adrenoreceptors on the ventricular myocardium reducing HR and CO.
ADRs: lethargy

Question 16

Summarise the features of direct renin inhibitors

Answer 16

Eg aliskiren

Binds to renin preventing cleavage of Ang to Ang1

Question 17

Summarise the features of centrally acing agents

Answer 17

Eg methyldopa, clonidine, moxonidine
Mechanism: reduce sympathetic outflow, reducing bp
ADRs: lethargy

Question 18

What are some causes of heart failure?

Answer 18

Ischaemic Heart Disease, Hypertension, Cardiomyopathies (e.g alcohol)

Question 19

What is the management for heart failure?

Answer 19

Pharmacological - diuretics, ACEi, beta-blockers etc

Lifestyle - exercise, stop smoking and drinking