Hypertension

Question 1

What can hypertension cause in the eyes?

Answer 1

Hypertensive retinopathy

Question 2

What can hypertension cause in the brain?

Answer 2

Stroke
Small vessel disease (dementia)

Question 3

What can hypertension cause in the heart?

Answer 3

Atherosclerosis
Heart failure

Question 4

What can hyper tendon cause in the kidneys?

Answer 4

Renal disease

Question 5

Why is home blood pressure measurement better than measuring blood pressure in the clinic?

Answer 5

Removes the factor of ‘white coat syndrome’

Question 6

List 5 causes of essential (idiopathic) hypertension?

Answer 6

Genetics
Salt intake
Alcohol
Sedentary lifestyle
Overweight

Question 6

List 5 causes of essential (idiopathic) hypertension?

Answer 6

Genetics
Salt intake
Alcohol
Sedentary lifestyle
Overweight

Question 7

List 5 causes of secondary hypertension

Answer 7

Coarctation of aorta (narrowing)
Decreased blood flow to kidneys (chronic kidney disease)
Primary aldosteronism
Phaechromocytoma (increased adrenaline release
Cushings syndrome

Question 8

Heart rate greater than x is classified as hypertensive

Answer 8

140/90 mmHg

Question 9

Heart rate greater than x is classified as severely hypertensive

Answer 9

180/110 mmHg

Question 10

What is radio-femoral delay?

Answer 10

When you can feel the pulse in the femoral artery before the radial artery

Question 11

What is renal bruit?

Answer 11

Turbulence in a vessel, can be caused by plaque

Question 11

What is renal bruit?

Answer 11

Turbulence in a vessel, can be caused by plaque

Question 12

Name 3 factors that would make a group high risk for hypertension

Answer 12

1 - pre existing cardiovascular disease
2 - diabetes mellitus
3 - chronic kidney disease

Question 13

What test is used to check for hypertension in the eyes?

Answer 13

Fundoscopy

Question 14

What test is used to check for hypertension in the brain?

Answer 14

CT or MRI (not common)

Question 15

What test is used to check for hypertension in the heart?

Answer 15

ECG
Echocardiodiagram
Cardiac MRI for left ventricular hypertrophy

Question 16

What test is used to check for hypertension in the kidneys?

Answer 16

Renal function test (U&Es)
Urine protein quantification (checks for glomerular damage)

Question 17

Name the 5 groups of first line drugs used for treatment of hypertension

Answer 17

C - calcium channel blockers
A - ACE inhibitors
D - Diuretics
B - Beta blockers
K+ sparing diuretics

Question 18

Which drug group is always given as a first choice?

Answer 18

Calcium channels blockers

Question 19

Which drug group is always given as a first choice?

Answer 19

Calcium channels blockers

Question 20

Name 3 main calcium channel blockers

Answer 20

Amlodipine
Nifedipine
Verapamil

Question 21

What drug class does amlodipine and nifedipine belong to?

Answer 21

Dihydropyridines
Only affects peripheral vasculature

Question 22

What drug class class does verapamil belong to?

Answer 22

Phenylalkyamine
Affects cardiac and peripheral vasculature

Question 23

Which calcium channel blocker has the longest half life?

Answer 23

Amlodipine

Question 24

What are possible side effects of calcium channel blockers?

Answer 24

Headache (due to vasodilation) Tachycardia (baroreceptor reflex) Ankle swelling (oedema)

Question 25

What determines whether calcium blockers or ACE/ARB are first line treatment?

Answer 25

Age Ethnicity

Question 26

Name 4 most commonly used ACE inhibitors for hypertension treatment

Answer 26

Ramipril Lisinopril Perindopril Enalapril

Question 27

Name 4 most commonly used ARB for hypertension treatment

Answer 27

Losartan Irbesartan Valsartan Candesartan

Question 28

What are possible side effects of ACE inhibitors and ARBs?

Answer 28

Hyperkalaemia Angioedema Renal impairment Cough (only ACE)

Question 29

How can ACE/ARBs cause hyperkalaemia?

Answer 29

Reducation of aldosterone -> less ion reabsorption in kidneys of sodium -> less excretion in kidneys of potassium

Question 30

What is the action of beta blockers for reducing hypertension?

Answer 30

Blocks beta 1 receptors to reduce renin release Blocks beta 1 receptors on heart to reduce contractility and chronotropy

Question 31

Name 4 beta blockers used in treatment of hypertension

Answer 31

Atenolol Bisaprolol Labetalol Carvedilol

Question 32

Which beta blocker is suitable for use in pregnancy?

Answer 32

Labetalol

Question 33

Which 2 beta blockers also block alpha 1 receptors?

Answer 33

Carvedilol Labetalol

Question 34

Which 2 beta blockers are long lasting?

Answer 34

Atenolol Bisaprolol

Question 35

What are side effect so beta blockers used in in hypertension?

Answer 35

Bradycardia Asthma/COPD (contraindication) Uncontrolled heart failure

Question 36

Which drug is favoured to be used after ACE/ARBs?

Answer 36

Thiazide like diuretics

Question 37

Name 3 thiazide/thiazide like diuretics used to treat hyper tension?

Answer 37

Bendroflumethiazide Indapamide Chlortalidone

Question 38

How do thiazide diuretics treat hypertension?

Answer 38

They block sodium and chloride channels on DCT -> less reabsorption of water -> lower circulation volume

Question 39

What are some side effects of thiazide like diuretics?

Answer 39

Hyperkalaemia Hypercalcaemia Hyponatraemia Gout Alkalosis

Question 40

What is the last resort drug after beta blockers that is used for treating hypertension?

Answer 40

K+ sparing diuretics

Question 41

How do K+ sparing diuretics treat hypertension?

Answer 41

Antagonises aldosterone -> reduces salt and water reabsorption without loss of potassium -> lowers circulating volume

Question 41

How do K+ sparing diuretics treat hypertension?

Answer 41

Antagonises aldosterone -> reduces salt and water reabsorption without loss of potassium -> lowers circulating volume

Question 42

Name 3 K+ sparing diuretics

Answer 42

Spironolactone Amiloride Eplerenone

Question 43

Name 3 K+ sparing diuretics

Answer 43

Spironolactone Amiloride Eplerenone

Question 44

What its first line drug treatment if under 55 with type 2 diabetes?

Answer 44

ACE/ARB

Question 45

What is first line drug treatment if over 55 and not of black Africa/Caribbean origin?

Answer 45

ACE/ARB

Question 46

What is first line drug treatment if over 55?

Answer 46

Calcium channel blocker

Question 47

What is first line drug treatment if of black African/Caribbean origin of any age?

Answer 47

Calcium channel blocker

Question 48

What is the second line of drug treatment?

Answer 48

Either ACE/ARBs or CCB, depending on what was given as the first line

Question 48

What is the second line of drug treatment?

Answer 48

Either ACE/ARBs or CCB, depending on what was given as the first line

Question 49

What is the third line of treatment for hypertension?

Answer 49

Thiazide like diuretics

Question 50

What is the fourth line of treatment for hypertension?

Answer 50

Beta blockers

Question 51

What is the 5th line of treatment for hypertension?

Answer 51

K+ sparing diuretics

Question 52

Why are patients older than 55 not given ACE/ARB as first line?

Answer 52

Renin is suppressed with age, therefore treatments that target the RAAS system will be less effective

Question 52

Why are patients older than 55 not given ACE/ARB as first line?

Answer 52

Renin is suppressed with age, therefore treatments that target the RAAS system will be less effective

Question 53

Why are those of black African/Caribbean origin always first line with CCB?

Answer 53

There is greater prevalence of high blood pressure in those of African origin, and ACE side effects are more common

Question 54

What patients are eligible for treatment of hypertension?

Answer 54

With BP >160/100 mmHg With BP >140/90 mmHg at high risk Anyone with a prior cardiovascular event Anyone that has a secondary cause with accelerated hypertension

Question 55

Is it better to reach the target blood pressure or lower than that?

Answer 55

Better to target a lower blood pressure, prevent blood pressure form rising again in the future

Question 56

List 3 methods of measuring blood pressure

Answer 56

Home BP test Clinic BP test ABPM (ambulatory blood pressure monitoring)