HTN and Cholesterol

Question 1

Stage 1 HTN defined as a clinic BP of >? and an ambulatory BP monitor daytime average of >?

Answer 1

Clinic BP >140/90

ambulatory BP >135/85

Question 2

Stage 2 HTN defined as what?

Answer 2

clinic BP >160/100

ambulatory BP >150/95

Question 3

Stage 3 HTN defined as what?

Answer 3

clinic systolic BP of 180 or more OR

clinic diastolic BP of 110 or more

Question 4

Normally, you expect BP to dip at night. If there is a difference in daytime and night-time readings of <10% what diagnosis should you explore?

Answer 4

sleep apnoea

Question 5

what 6 measures of lifestyle intervention should be offered to everyone with HTN?

Answer 5

1. diet - high in fruit and veg and low in fat
2. regular physical exercise - 30mins moderate aerobic exervcise 5-7 days a week
3. reduce alcohol intake
4. reduce dietary sodium intake
5. smoking cessation
6. weight reduction

Question 6

HTN treatment should be offered to all people <80yrs old with stage 1 HTN and at lease one of which factors (5)

Answer 6

1. target organ damage
2. CVD
3. renal disease
4. DM
5. 10 yr cardiovascular risk of >20% (lipid lowering therapy is given if 10yr risk >10%)

Question 7

what is first line treatment of HTN in a patient who is <55yrs old and not of black African or African-carribean origin?

Answer 7

Ace inhibitor
or
ARB

Question 8

what is first line treatment of HTN in someone over 55yrs or someone from black african or african-carribean family origin

Answer 8

calcium channel blocker

Question 9

what is first line treatment for a T2DM patient with HTN?

Answer 9

Ace inhibitor or ARB

Question 10

2nd then 3rd steps for someone <55 and not of black origin for treating HTN?

Answer 10

2nd CCB

3rd thiazide-like diuretic

Question 11

2nd then 3rd steps for someone >55 or of black origin?

Answer 11

2nd ACE inhibitor or ARB

3rd thiazide-like diuretic

Question 12

step 4 for everyone with HTN

Answer 12

if blood potassium <4.5 choose low-dose spironolactone

if blood potassium >4.5 choose alpha or beta blocker

Question 13

Name 5 tests that should be offered to someone with HTN to check for cardiovascular risk and target organ damage

Answer 13

1. Urine sample - to get an estimate of the albumin:creatinine ratio to check for protein in the urine
2. urine dipstick to test for haematuria
3. Blood sample - plasma glucose, electrolytes, eGFR, creatinine, serum total cholesterol and HDL
4. examine fundi for presence of hypertensive retinopathy
5. 12 lead ECG

Question 14

what is particularly important to monitor in people taking ACE inhibitors?

Answer 14

eGFR - it should not drop by >25% after taking anti-hypertensives

Question 15

Name 4 adverse effects of ACE inhibitors

Answer 15

1. hypotension (particularly first dose hypotension)
2. persistent dry cough
3. hyperkalaemia
4. they can cause or worsen kidney failure
5. Rare = angioedema and anaphylactoid reactions

Question 16

patients with what 2 conditions should ACEi be avoided in?

Answer 16

1. renal artery stenosis
2. AKI
3. avoid in pregnant/breastfeeding women

Question 17

What two drugs should be avoided being used alongside ACE inhibitors?

Answer 17

1. potassium elevating drugs e.g. K+-sparing diuretics

2. NSAIDs - together they increase risk of nephrotoxicity

Question 18

When/how often should renal function be tested when starting ACEi?

Answer 18

1. before treatment
2. 3 months after starting
3. then annually

Question 19

How can you assess CVD risk in people?

Answer 19

QRISK2 risk assessment tool

Question 20

What percentage 10yr risk does someone need to have to be offered a statin?

Answer 20

10%

Question 21

what cholesterol-lowering drug should be offered, and at what dose, as primary prevention of CVD?

Answer 21

Atorvastatin 20mg

Question 22

what dose of atorvastatin should you start for a person with CVD?

Answer 22

80mg

Question 23

how soon after starting statin treatment should you test cholesterol levels? What percentage of reduction should you ideally have reached?

Answer 23

after 3 months - aim for a greater than 40% reduction in non-HDL cholesterol.

Question 24

what are the two most common adverse effects to statins?

Answer 24

headache

GI disturbance

Question 25

what are the more serious but rarer side effects to statins

Answer 25

effects on muscles causing myalgia

Question 26

the metabolism of statins is reduced by CYP3A4 inhibitors. What does this mean to the amount of statin that will be in the body if given with one of these?

Answer 26

it will increase as it is not being broken down. Could put patient at more increase of side effects

Question 27

Name some drug interactions with statins

Answer 27

o	Amiodarone 
o	Diltiazem 
o	Itraconazole 
o	Macrolide antibiotics 
o	Protease inhibitors 
o	Grapefruit juice (however, one half of a grapefruit daily is unlikely to increase risk of adverse interactions or muscle injury)

Question 28

if needing to give a macrolide antibiotic to a patient on statins, what is the best ting to do to avoid interaction?

Answer 28

stop the statin until the antibiotic course is finished

Question 29

Can you continue to give atorvastatin to a patient also taking amlodipine?

Answer 29

yes but statin dose should not exceed 20mg