Vascular disease, hypertensive disorder, neoplasms

Question 1

Threshold for pharmacological intervention in hypertension

Answer 1

SBP > 130
DBP > 80

AND one of
- ASCVD- ischaemic heart disease, PAD, previous stroke, congestive HF
- 10-year ASCVD >10%

All adult with SBP >140, DBP >90

Question 2

First line antihypertensives

Answer 2

ACEi
ARBs
Thiazides
DHP CCB

non-DHP CCB

Question 3

Second line antihypertensives

Answer 3

Beta-blockers
Loop diuretics
Potassium sparing diuretics
alpha-1 blockers

Direct renin inhibitors (rare)
alpha-2 blockers (rare)

Direct arteriolar vasodilators

Question 4

When are beta-blockers recommended first-line for HTN

Answer 4

IHD
HF
AF
Thoracic aortic disease
Thyrotoxicosis
Migraine
Essential tremor

Question 5

When is aldosterone specifically preferred for HTN

Answer 5

Primary hyperaloderism

Question 6

What antihypertensive is best suited in osteoporosis?

Answer 6

Thiazide diuretics- decreases renal calcium secretion

Question 7

Follow-up time frame after starting antihypertensives

Answer 7

1 month
- check electrolytes and cr (ARB, ACEi)

Consider 2 weeks in:
- initial hyponatraemia started on thiazide
- CKD with high cr/ K started on ARB/ ACEi

Question 8

Follow-up time frame for non-pharamacological management of HTN

Answer 8

3-6 months
- start medication if uncontrolled

Question 9

When to discontinue ACEi/ ARBs for HTN

Answer 9

Cr increase >30% from baseline
Hyperkalaemia
Fluid rentention

Question 10

Antihypertensive medication titration based on:
- hyponatraemia
- hypokalaemia
- hyperkalaemia
- cough

Answer 10

hyponatraemia
- stop/ avoid thiazide. Consider loop diuretics

hypokalaemia
- exclude hyperaldosteronism
- consider thiazide sparing diuretics

hyperkalaemia
- thiazide diuretics

cough
- switch ACEi to ARBs

Question 11

Most effective lifestyle intervention for HTN and its SBP reduction

Answer 11

Weight loss
- 1 mmHg for every kilo loss in overweight patients

Question 12

Most effective diet for HTN and its SBP reduction

Answer 12

DASH diet
- 11 mmHg reduction

Question 13

Renal biopsy features of chronic aterial hypertenion (hypertensive nephrosclerosis)

Answer 13

arterial/ ateriolar sclerosis
hyalinosis