Hypertension

Question 1

Stage 1 HT

Answer 1

135/85 - 149/94 ambulatory

Question 2

Management plan for stage 1 Ht

Answer 2

Lifestyle advice
Consider treatment

Question 3

Who to start treatment for in stage 1 ht

Answer 3

Over 80 with clinic BP >150/90

Under 80 with renal disease, diabetes, CVD, or 10% QRISK

Under 60 with QRISK 10%

Question 4

What is stage 2 ht

Answer 4

> 150/95

Question 5

What is stage 3 ht

Answer 5

> 180/120

Question 6

What is 1st line for <55 without AfroCarribean origin

Answer 6

ACEi
ARB

Question 7

What is 1st line for >55 afrocarribean origin with T2DM

Answer 7

ACEi/ARB

ARB preferred

Question 8

What are the 2nd line options in >55 with T2DM

Answer 8

CCB
Thiazide like diuretic

Question 9

What are the 2nd line options for <55 of AfroCarribean origin

Answer 9

ACEi/ARB
Thiazide like diuretic

Question 10

What is 1st line for <55 AfroCarribean

Answer 10

CCB

Question 11

What is 1st line for >55

Answer 11

CCB

Question 12

What is 3rd line treatment for HT

Answer 12

ACEi/ARB
CCB
Thiazide like diuretic

Question 13

What are the 4th line options for HT

Answer 13

Potassium <4.5mmol/L = low dose spironolactone

Potassium >4.5mmol/L = alpha or beta blocker

Question 14

When are thiazide diuretics used earlier in the HT steps

Answer 14

Pt with heart failure

Question 15

ACEi examples

Answer 15

Captopril
Enalapril
Fosinopril
Lisinopril
Perindopril
Ramipril

Question 16

What are the side effects of ACEis

Answer 16

Cough
HYPERkalaemia
Hepatic failure
Angiodema
Renal impairment
Dizziness
Headaches

Question 17

ARBs example

Answer 17

Candesartan
Irbesartan
Losartan
Olmesartan
Valsartan

Question 18

Side effects of ARBs

Answer 18

HYPERkalaemia
Hepatic failure
Angioedema
Renal impairment
Dizziness
Headaches

Question 19

ACEi/ARB interactions

Answer 19

Increased risk of renal failure - ksparing diuretics, NSAIDs

Increased risk of HYPERkalaemia - THANKB

Increased risk of volume depletion - Diuretics

Increases plasma levels of LITHIUM

Question 20

What is monitored before starting ACEi/ARB

Answer 20

Renal function
Electrolytes

Question 21

How often does ACEi/ARB need to be monitored

Answer 21

1-2 weeks after starting
1-2 weeks after each dose increase
Check BP every 4 weeks after each dose titration

Question 22

Name alpha blockers

Answer 22

Alfuzosin
Doxazosin
Temsulosin
Terazosin

Question 23

What are cautions and contraindications of alpha blockers

Answer 23

Pts with postural HT
Pts with micturition syncope - fainting whilst urinating

Caution/avoid in pregnancy and breastfeeding

Question 24

Which are the cardio selective beta blockers

And why choose them

Answer 24

Less likely to cause bronchospasms - asthma

BAtMAN

Bisoprolol
Atenolol
Metoprolol
Acebutalol
Nebivolol

Question 25

Major side effect of alpha blockers and advice

Answer 25

HYPOtension First dose take at bedtime due to dizziness

Question 26

Name beta blockers

Answer 26

Atenolol Bisoprolol Carvedilol Labetalol Propranolol Sotalol Timolol

Question 27

Which are the water soluble beta blockers Why choose them

Answer 27

Less likely to cross BBB - less nightmares water CANS Celiprolol Atenolol Nadolol Sotalol

Question 28

Which are intrinsic sympathomimetic Why choose them

Answer 28

Less likely to cause cold extremeties - cold sensitivity s/e Ice PACO Pindolol Acebutalol Celiprolol Oxprenolol

Question 29

What are side effects of beta blockers

Answer 29

Bronchospasms - C/I in asthma unless last line - use cardioselective Bradycardia and heart failure HYPERglycaemia - can mask symptoms of HYPO

Question 30

Key interaction with Beta blocker

Answer 30

Digoxin - HEART BLOCK

Question 31

Name calcium channel blockers Two types

Answer 31

Dihydropyridine: amlodipine, felodipine, lacidipine, lercandipine, nifedipine Rate limiting: diltiazem, verapamil

Question 32

Side effects of CCBs

Answer 32

Dizziness headaches Gingival hyperplasia - swollen gums Peripheral oedema Flushing ATRIOVENTRICULAR BLOCK - diltiazem and verapamil

Question 33

If BP is >140/90 and pregnant What is 1st 2nd 3rd line treatment

Answer 33

Late Night Munchies Labetalol Nifedipine Methyldopa

Question 34

What is BP target for pregnant patients once on treatment

Answer 34

135/85

Question 35

If patient develops pre-eclampsia new >140/90 What is treatment plan

Answer 35

Take aspirin FROM week 12 till birth

Question 36

What is BP target for <80 with or without T2DM

Answer 36

140/90

Question 37

What is BP target for >80 with or without T1/2DM

Answer 37

150/90