Hypertension

Question 1

It used to be ABCD what is it now?

Answer 1

ACD
no more beta blockers as first line

Question 2

Who gets ACEi/ARBs?

Answer 2

People under 55
or people with T2DM

Question 3

Who gets CCB?

Answer 3

Over 55 or Black
note: NOT thiazide-like diuretics

Question 4

What about if A or C doesn’t work?

Answer 4

A+ C or D
C + A or D

Question 5

What does D stand for + give examples

Answer 5

thiazide-like diuretics
Indapamide

Question 6

What to prescribe in people with hypertension over 55 or Black

Answer 6

Calcium channel blockers like amlodipine

Question 7

What to do if the above hasn’t worked?

Answer 7

Step 4 is:
Ask about medication compliance
Think about postural hypotension (if the reading is taken immediately after standing up, causing a temporary spike in blood pressure as the body tries to compensate for the sudden drop due to the postural change)
Consider additional medication or specialist referral

Question 8

Which medication would you consider adding if someone has treatment resistant hypertension?

Answer 8

Beta blocker/alpha blocker
Low dose mineralocorticoid receptor antagonist

Question 9

Name a mineralocorticoid receptor antagonist

Answer 9

Spironolactone

Question 10

How do you decide between a beta blocker/alpha blocker and a low dose mineralocorticoid receptor antagonist

Answer 10

Depends on the potassium. Since MCRA can increase potassium levels, only prescribe if:

K <4.5 or equal to 4.5

If K above 4.5, you can give a beta blocker