Treatment

Question 1

As step 1 treatment, who would you offer an ACEi or ARB to?

Answer 1

• Patients with T2DM

- <55 but not of African or African-Caribbean origin

Question 2

As step 1 treatment, who would you offer a CCB to?

Answer 2

• > 55 and do not have T2DM

- Are of black African or African-Caribbean origin and do not have T2DM

Question 3

What would you offer as 1st line treatment if a CCB is not well tolerated or patient has HF?

Answer 3

Thiazide-like diuretics

• 1st Indapamide
• 2nd Bendroflumethiazide or hydrochorothiazide

Question 4

What are common side effects of CCB?

Answer 4

• Ankle swelling
• Flushing
• Headaches
• Palpitations

Question 5

Would you give an ACEi or ARB to African or African-Caribbean patients?

Answer 5

ARB

Question 6

What would you consider before stepping up treatment?

Answer 6

• Discussing adherence with the patient
• Reviewing medications to make sure they are taking the optimal dose
• Assess for postural hypotension
• Assessment of BP at home with ABPM or HBPM

Question 7

If HTN is not controlled with taking step 1 treatment of an ACEi or ARB, what would you give?

Answer 7

Add a:
- CCB
OR
- Thiazide-like diuretic

Question 8

If HTN is not controlled with taking step 1 treatment of a CCB, what would you give?

Answer 8

Add a:
- ACEi
OR
- ARB
OR
- Thiazide-like diuretic

Question 9

If HTN is not controlled with step 2 treatment, what would you give?

Answer 9

ACEi/ARB
\+
CCB
\+
Thiazide-like diuretic

Question 10

If HTN is not controlled with step 3 treatment, what would you do?

Answer 10

o Confirm elevated clinic BP measurements using ABPM or HBPM
o Assess for postural hypotension
o Discuss adherence
o Seek specialist advice

Question 11

If HTN is not controlled with step 3 treatment, what would you give?

Answer 11

Low-dose spironolactone - diuretic

• K+ <4.5mmol/l
• Use in caution with reduced eGFR

Alpha- (doxazosin) or Beta-blocker
- K+ >4.5mmol/l

Question 12

When would you refer a patient for same day specialist review?

Answer 12

Clinic BP >180/25 mmHg with:
o Signs of retinal haemorrhage or papilloedema
OR
o Life threatening symptoms such as: new onset confusion, chest pain, signs of HF or AKI

Question 13

What is a common side effect of ACEi?

Answer 13

Tickly cough

Question 14

What is a common side effect of Beta-blockers?

Answer 14

Bradycardia

Question 15

What is a common side effect of Thiazide-like diuretic?

Answer 15

• Hypotranaemia, Hypokalaemia, hypercalcaemia
• Impaired glucose tolerance
• Gout
• Postural hypotension
• Gout

Question 16

What is a common side effect of Loop diuretic?

Answer 16

Gout attack

Question 17

What is a common side effect of Aldosterone antagonists?

Answer 17

Hyperkalaemia

Question 18

What antihypertensives are safe during pregnancy?

Answer 18

1. Labetalol
2. Methyl dopa
3. Nifedipine

Question 19

Give an example of an ARB

Answer 19

Candesartan

Question 20

Give an example of a thiazide-like diuretic

Answer 20

• Indapamide
• Bendroflumethiazide
• Hydrochlorothiazide

Question 21

Give an example of an ACEi

Answer 21

• Lisinopril

- Ramipril

Question 22

Give an example of an Beta-blocker

Answer 22

Labetalol

Question 23

Give an example of an CCB

Answer 23

• Amlodipine

- Diltiazem

Question 24

Give an example of an loop diuretic

Answer 24

Furosemide

Question 25

Give an example of an Aldosterone antagonist

Answer 25

Spironolactone

Question 26

What is stage 1 HTN and when do you treat it?

Answer 26

For a person < 80, with stage 1 hypertension, only treat medically if: diabetic, renal disease, QRISK2 >10%, established coronary vascular disease, or end organ damage
<150/95