Hypertension

Question 1

What is stage 1 hypertension

Answer 1

Clinic BP 140/90mmHg - 159/99mmHg

HBP 135/85mmHg - 149/94mmHg

Question 2

What is stage 2 hypertension

Answer 2

Clinic BP - 160/100 mmHg or higher but less than 180/120 mmHg

HBP - 150/95 or higher

Question 3

What is severe hypertension

Answer 3

Clinic systolic BP of 180 mmHg or higher or
Clinic diastolic BP of 120 mmHg or higher

Question 4

What is given for hypertension in type 2 diabetes

Answer 4

ACE Inhibitor

Question 5

What is given for hypertension in type 2 diabetes in Black Afro-Carribbean

Answer 5

ARB

Question 6

What is given for hypertension in under 55 and not Black Afro-Carribbean

Answer 6

ACE Inhibitor

Question 7

What is given for hypertension in over 55’s

Answer 7

Calcium Channel Blocker

Question 8

What is given for hypertension in Black Afro-Caribbean of any age

Answer 8

Calcium Channel Blocker

Question 9

What is the BP target for under 80s

Answer 9

Clinic BP <140/90

HBPM <135/85

Question 10

What is the BP target for over 80s

Answer 10

Clinic BP <150/90

HBPM <145/85

Question 11

When can low dose spironolactone be given in hypertension

Answer 11

Step 4: If potassium is <4.5

Question 12

When can an alpha blocker or a beta blocker be given in hypertension

Answer 12

Step 4: If potassium is >4.5

Question 13

What is the BP target for under 80s with type 1 diabetes

Answer 13

Clinic BP:

If ACR <70 : <140/90
If ACR >70 : <130/80

Question 14

What is the BP target for over 80s with type 1 diabetes

Answer 14

Clinic BP: <150/90

Question 15

What is the BP target for patients with CKD and a ACR <70

Answer 15

Clinic BP below 140/90mmHg

Question 16

What is the BP target for patients with CKD and a ACR >70

Answer 16

Clinic BP below 130/80mmHg

Question 17

What is the BP target for pregnant women with chronic hypertension

Answer 17

<150/100mmHg

Question 18

What is the BP target for pregnancy women with chronic hypertension and if target organ damage/given birth

Answer 18

<140/90mmHg

Question 19

What is first line for hypertension in pregnancy

Answer 19

Labetalol

Question 20

What can be given for hypertension in pregnancy if first line is not suitable

Answer 20

Second line: Nifedipine MR

Third line: Methyldopa

Question 21

When does methyldopa need to be stopped

Answer 21

2 days after birth

Question 22

What can be given in an emergency setting for severe hypertension or severe pre-eclampsia or if they have or have previously had an eclamptic fit

Answer 22

Magnesium Sulfate

Question 23

What is first line for hypertension post birth/ breastfeeding in non black afro carribbeans

Answer 23

Enalapril

Question 24

What is first line for hypertension post birth/ breastfeeding in black afro carribbeans

Answer 24

Nifedipine or Amlodipine

If not controlled with single drug consider a combination. If this combination is not tolerate or ineffective consider either adding labetalol or atenolol to the combination or swapping.

Question 25

Which ACE Inhibitor needs to be taken 30 to 60 minutes before food

Answer 25

Perindopril

Question 26

Which ACE Inhibitor is taken twice daily

Answer 26

Captopril

Question 27

Can ACE Inhibitors be given in pregnancy

Answer 27

NO - AVOID

Question 28

What are the common adverse reactions / side effects with ACE Inhibitors

Answer 28

Persistent dry cough Hyperkalaemia Higher risk in renal impairment and diabetes mellitus Angioedema Dizziness and headaches Hepato-biliary disorders - Cholestatic jaundice, hepatic failure, Stop if LFTs 3x normal or jaundice occurs Other common adverse effects: Abdominal discomfort, alopecia, arrhythmias, chest pain/angina, constipation, diarrhoea, drowsiness, dry mouth, dyspepsia, dyspnoea, n&v, rash, myalgia, rhinitis, taste disturbance and vertigo, hypOglycaemia

Question 29

What are the common interactions with ACE Inhibtors

Answer 29

HYPERKALAEMIA Aliskeren, ARB, K sparing diuretics / aldosterone antagonists, ciclosporin, heparin, trimethoprim NEPHROTOXICITY AND REDCUED eGFR NSAIDs (afferent arteriole constriction) HYPOTENSION Diuretics (volume depletion = low BP) RENAL IMPAIRMENT Avoid concomitant ACE + ARB (diabetic neuropathy) DIGOXIN Concomitant use with captopril can increase plasma concentrations of digoxin ALLOPURINOL Possible increased risk of leucopenia and hypersensitivity reactions, especially in people with renal impairment LITHIUM Concomitant use can increase plasma levels of lithium. Regular monitoring of serum lithium