Hypertension

Question 1

Define hypertension

Answer 1

sustained elevated BP above 140/90mmHg

Question 2

How is hypertension diagnosed?

Answer 2

• usually asymptomatic
• routine screening
• clinic - misdiagnosed

Question 3

Describe the hypertension NICE classification

Answer 3

Stage 1 - 140/90mmHg
Stage 2 - 160/90mmHg
Stage 3 - 180/120mmHg

Question 4

What is a suitable BP?

Answer 4

120/80mmHg

Question 5

What are the modifiable risk factors of hypertension?

Answer 5

diet, exercise, smoking, alcohol and obesity

Question 6

what are the non-modifiable risk factors of hypertension?

Answer 6

family history, ethnic origin, age and gender

Question 7

According to the NICE guidelines, what is the 1st line of treatment for hypertension for patients over 55years?

Answer 7

ACEI/ARBs such as ramipril/candesartan

Question 8

What is the mechanism of action of ACEI/ARB?

Answer 8

inhibit ACE, which inhibits Ang II and bradykinin which reduces vasoconstriction and SNS activation. It reduced aldosterone with decreases fluid retention decreasing PVR

Question 9

What are the side effects of ACEI/ARB?

Answer 9

1st dose hypotension
cough
headaches
dizziness
fluid retention
hyperkalaemia

Question 10

According to the NICE guidelines, what is the 1st line of treatment for hypertension for patients under 55 years?

Answer 10

CCB such as amlodipine

Question 11

What is the mechanism of action of CCB?

Answer 11

inhibit Ca2+ influx via voltage gated channels decreasing HR, contractility and cardiac output. Block influx into arterioles leading to arteriolar dilation which reduces PVR

Question 12

What are the side effects of CCB?

Answer 12

flushing
headaches
dizziness
ankle swelling

Question 13

What are the benefits and limitations of monotherapy?

Answer 13

benefits - compliance, cheaper, fewer side effects and interactions

limitations - target BP levels achieved in fewer than 40% of patients (combination therapy more than 60%)