W 11 Hypertension

Question 1

What are the symptoms of Hypertension?

Answer 1

Severe headaches.
Nosebleed.
Fatigue or confusion.
Vision problems.
Chest pain.
Difficulty breathing.
Irregular heartbeat.
Blood in the urine.

Question 2

What are the most common drugs to treat hypertension?

Answer 2

A - ACE inhibitors (~pril) (common SE=dry cough), Alpha 1 receptor blockers (eg. Doxazosin) (common SE = Dizziness), Angiotensin 2 receptor blockers (~sartans) (common SE=hyperkalaemia)
B - Beta blockers (~olol) (common SE=nightmares) - No longer a first line treatment for hypertension
C - Calcium channel blockers (amlodipine) (common SE = peripheral edema)
D - Diuretics - thiazide diuretics (…mide) (common SE=increase of gout risk)
E - everything else

Question 3

Side Effects of Drugs?

Answer 3

Metoprolol (Beta blocker):dizziness,nightmares,cold fingers and toes
Enalapril (ACE inhibitor):cough (dry) that does not go away.headache.diarrhoea.
Bendroflumethiazide (Diuretic/thiazide diuretic): dry mouth.stomach pain,constipation.severe joint pain (increased gout risk).
Amlodipine (CCBs):Peripheral oedema,Excess fluid in the lungs (pulmonary edema)Headache
Doxazosin (alpha blocker):Headache, dizziness, Tiredness or weakness,Change in heartbeat, short of breath, Blurred vision, runny or blocked nose
Nifedipine (CCBs):Grapefruit juice intolerance,headache,
Losartan (ARB):Blurred vision. hyperkalaemia,

Question 4

What other complications may cause Hypertension?

Answer 4

Hypertension can cause blindness or vision changes,stroke, IHD (can rupture the vessels).

Question 5

What is the first line drug treatment for hypertension?

Answer 5

First line: A (ACEi, Angiotensin 2 receptor blockers),C,D

Question 6

What questions would you need to ask before you can recommend a treatment ?

Answer 6

What medications are you on? Are you taking ACE inhibitors? (the time they have been on ACEI is important) How long have you been on these medications?
What type of cough do you have? dry or productive?
How long has the cough been going on?
History of asthma?
How long have they been on their medication? (new medication and new cough could indicate side effect)
Any pre-existing health conditions?
Whether they have a fever? (to determine whether there is a bacterial infection)
Any other symptoms other than a cough? (e.g. wheezing- could be asthma if present)
Have they been overseas? ie. rule out COVID

Question 7

What do you mean by differential diagnosis?

Answer 7

A differential diagnosis is a list of possible conditions or diseases that could be causing your symptoms. It’s based on the facts obtained from your symptoms, medical history, basic laboratory results, and a physical examination.

Question 8

What possible differential diagnosis would you consider?

Answer 8

Cough (dry) due to taking an ACE inhibitor (side effect) –> check BP to see if medication is working or not
Unlikely if they have been on ACEi for 1 year compared to recently starting the medication
If cough is not bad then ask them to wait for a couple of days and if it doesn’t subside then tell them to see the GP
If this is the case, do not recommend cough suppressants → see GP to possibly change dose of ACEi, or change type of medication (any other first line treatments eg. ARBs-well tolerated)
Asthma
Viral infection → symptomatic treatment
Bacterial infection → antibiotics
COVID
allergies

Question 9

He would like to get his blood pressure checked at your pharmacy. He is a very big man with massive arms that are too big for the cuff of the blood pressure monitor. How would you deal with the situation?

Answer 9

Recommend he see a Dr and explain that a correctly sized cuff is really important to getting an accurate reading.

Question 10

Mark Wilson is a 56-year-old electrician who is concerned about his blood pressure and potential for ‘heart problems’. His brother had a ‘heart attack’ a few months ago, at 58 years old. Mark runs his own business and says he has little time for exercise due to his long working hours. His BMI is 31 kg/m2. Mark enjoys a few glasses of beer most nights and smokes 15 cigarettes a day. At a recent visit to his GP, Mark’s blood pressure reading was 185/100 mmHg. Mark’s GP monitored his blood pressure on three occasions (average reading is 180/95), and ordered blood glucose and lipids tests.A few days later, Mark’s blood results come back, and his GP asks for your opinion (as the GP Practice Pharmacist) on what medicines Mark should be prescribed. Mark does not currently take any regular or over the counter medicines, and has no known allergies.

Answer 10

What tests need to be done for hypertension patients? why?

Random blood glucose: Random blood glucose helps to identify hyperglycemia chronic complications. Help to find out diabetes complications.

Triglycerides:triglycerides determine your risk of developing heart disease.

HDL: High HDL-C presents protect against heart disease and low lavel means to determine unhealthy lipids and your risk of developing heart disease

LDL: High HDL-C is thought to protect against heart disease

Total Cholesterol:measures the amount of each type of cholesterol and certain fats in your blood.

Question 11

If a patient has diabetes with hypertension what treatment will you give?

Answer 11

Use ARBs and ACEi (renal protective; protects kidneys from harmful effects of diabetes)

ARB : Losartan, Candasartan,Valsartan

Question 12

What would be different treatment goals for hypertension patients?

Answer 12

The first goal for Newly diagnosed hypertension is reduce blood pressure and potential for ‘heart problems’
Manage risks associated with raised lipids.
Consider the place of aspirin for primary prevention.
Optimise management of cardiovascular risk via lifestyle modification.

Question 13

How will you treat hypertension and available treatment options?

Answer 13

ACEi (Pril)
CCB (pine)
ß-blocker as a cardio protective(lol)
If patient with increased lipids then add blood thinner like statin to reduce LDL
In addition add 75 to 100mg aspirin tablets as blood thinner

Question 14

What are the non pharmacological treatment options of hypertension?

Answer 14

Reduce/stop smoking
Reduce alcohol consumption
Eat a balanced diet and reduce salt intake
Exercise regularly
low salt and low fat diet
Recommend he eats a balanced diet (and reduces salt intake) to help him lose weight.
Recommend he joins a smoking cessation programme, e.g. Quit
Relaxation Techniques.
Self-Measured Blood Pressure Monitor

Question 15

Which one of the following is the most appropriate choice for hypertension in a patient with diabetes?

Answer 15

ACEi or ARB

Question 16

Which one of these would be the most appropriate choice for hypertension post M.I?

Answer 16

Metoprolol

Question 17

Which one of the following side effects would you mention to a patient recently started on diltiazem?

Answer 17

Leg oedema

Question 18

Some important information to tell a patient newly started on doxazosin is to:

Answer 18

take the first dose at bedtime (to avoid dizziness/faintness)

Question 19

A patient with HTN, renal insufficiency plus ACEi develops a cough: next best option?

Answer 19

Losartan

Losartan is ARB

Question 20

Which ONE of the following is likely to be MOST EFFECTIVE at lowering BP long term?

Answer 20

Lose 5-7kg in body weight

Question 21

Which of the following has been shown to reduce left ventricular hypertrophy?

Answer 21

Indapamide

Question 22

Which ONE of these can potentially cause hypertension?

Answer 22

Oral contraceptive

Question 23

Vasodilation-type side effects (headache, flushing) occur with drugs like verapamil because they:

Answer 23

Block the movement of calcium across smooth muscle cells

Question 24

What is white coat syndrome?

Answer 24

Blood pressure above normal range