Cardiovascular drugs 2

Question 1

How many adults does hypertension affect in the UK?

Answer 1

1 in 4

Question 2

What is hypertension a major risk factor for?

Answer 2

MI
Stroke
Chronic kidney disease
Heart failure
Dementia

Question 3

What happens for every 10mmHg reduction in systolic blood pressure?

Answer 3

17% reduction of CHD
27% reduction of stroke
28% reduction of heart failure
13% reduction in all causes of mortality

Question 4

What is hypertension?

Answer 4

Clinic BP >140/90

Question 5

How is hypertension diagnosed?

Answer 5

Take a second or third measurement
Offer ambulatory blood pressure monitoring
If patient unable to tolerate ambulatory blood pressure monitoring - offer home blood pressure monitoring

Question 6

What will affect the BP reading?

Answer 6

Cuff too small - 10 to 40 increase
Cuff over clothing - 10 to 40 increase or decrease
Back/feet unsupported - 5 to 15 increase
Legs crossed - 5 to 8 increase
Not resting (3-5mins) 10-20 increase
Patient talking 10 to 15 increase
Pain 10 to 30 increase

Question 7

Describe home blood pressure monitoring

Answer 7

2 consecutive seated measurements, at least 1 minute apart
Blood pressure is recorded twice a day for at least 4 days - 1 week
Measurements on 1st day are discarded

Question 8

What blood pressures consist of hypertension diagnosis

Answer 8

Clinic BP >140/90

ABPM/HBPM> 135/85

Question 9

What are the outcomes of monitoring blood pressure for diagnosis?

Answer 9

Normotensive by both methods - true normontension
Hypertensive by both methods - true hypertension
Hypertensive based on office BP and normotensive by ABM/HBPM - White coat hypertension
Normotensive by clinic BP and hypertensive by ABP/HBPM - Masked hypertension

Question 10

What are the causes of hypertension?

Answer 10

Primary - Essential >90%

Secondary <10%

• renal disease - renovascular disease, renal parenchymal disease
• Endocrine disease - conns, cushings, phaeochromocytoma
• Drugs - COC pills, steroids, NSAIDs, Cocaine, EPO
• Vascular
• Others - obstructive sleep apnoea. pregnancy

Question 11

List some contributing factors to hypertension

Answer 11

High BMI
> 14 units of alcohol a week 
salt intake
lack of exercise
stress
caffeine

Question 12

List the risk factors for hypertension

Answer 12

Male
Age
Family history 
Ethnicity
Smoker
Cholesterol
Diabetes

Question 13

Describe the pathophysiology of hypertension

Answer 13

BP = CO X SVR

CO = HR X SVR

Question 14

Describe the symptoms of hypertension

Answer 14

Asymptomatic 
Headache 
Blurred vision 
Dizziness
Shortness of breath 
Palpitations
Epistaxis

Question 15

What examinations are necessary in terms of hypertension

Answer 15

Cardiovascular system
Abdomen
Fundoscopy

Question 16

What investigations are necessary in terms of hypertension

Answer 16

Urinalysis - Proteinuria, haematuria
ECG - LVH, AF
Blood tests - U&Es, LFTs, lipids, glucose/HBA1C

Question 17

Describe the non drug treatment of hypertension

Answer 17

Weight reduction
DASH diet 
Dietary sodium restriction 
Physical activity 
Alcohol moderation

Question 18

What is the drug choice for hypertension

Answer 18

ACEi/ARBs - hypertension with type 2 diabetes or age <55 and not of afrocarribean origin.

CCB - Hypertension without type 2 diabetes, age >55, black african or afrocarribean origin

If these do not work - add CCB, ACEi/ARBs or thiazide like diuretics

Resistant hypertension is when none of these drugs work and low dose spironolactone or alpha or beta blocker used

Question 19

What must be monitored when using ACEi/ARBs

Answer 19

Check Serum creatinine and potassium - before staring therapy 1-2 weeks
If serum creatinine increases by >50% or GFR falls >25% or K>6 - stop drug, repeat tests and consider other causes