Hypertension

Question 1

What is the minimum systolic blood pressure for diagnosis of stage 1 hypertension?

Answer 1

Stage 1 Hypertension is classified as a blood pressure above 140/90mmHg

N.b. between 120-139 systolic it is referred to as prehypertension

Question 2

What is the difference between primary & secondary hypertension?

Answer 2

• Primary hypertension has no known/ready identifiable cause and makes up about 90% of all cases of hypertension
• Secondary hypertension makes up the remaining number of cases and has a clear underlying cause (such as Conn’s syndrome or a phaeochromocytoma)

Question 3

Suggest FOUR non-pharmacological interventions you can tell a patient to make to reduced their blood pressure.

Answer 3

• Stop smoking
• Reduced fat intake (specifically saturated fat)
• Exercise more
• Reduce salt

Question 4

Patient’s are normally asymptomatic when they present with hypertension, however, what possible symptoms/signs may be visible?

Answer 4

• Light-headedness
• Headaches
• Vertigo
• Symptoms/signs of an underlying cause

Question 5

Mr. J is a black 42 year old gentleman who has just been diagnosed with hypertension. Outline the treatment pathway/plan for Mr. J including what changes you would make at each stage if the hypertension was resistant to treatment.

Answer 5

Stage 1 - Start on a CCB (most likely a dihydropyridine)
Stage 2 - Combination with an ACEi OR ARB (do NOT give both an ACEi & ARB)
Stage 3 - Consider adding a thiazide-like diuretic
Stage 4 - Consider adding spironolactone or a Beta blocker

Question 6

Mr. A is an asian 47 year old gentleman who has just been diagnosed with hypertension. Outline the treatment pathway/plan for Mr. J including what changes you would make at each stage if the hypertension was resistant to treatment.

Answer 6

Stage 1 - Start on a ACEi/ARB
Stage 2 - Combination with an CCB
Stage 3 - Consider adding a thiazide-like diuretic
Stage 4 - Consider adding spironolactone or a Beta blocker

Question 7

Mrs. W is a white 76 year old women who has just been diagnosed with hypertension. Outline the treatment pathway/plan for Mr. J including what changes you would make at each stage if the hypertension was resistant to treatment.

Answer 7

Stage 1 - Start on a CCB (most likely a dihydropyridine)
Stage 2 - Combination with an ACEi OR ARB (do NOT give both an ACEi & ARB)
Stage 3 - Consider adding a thiazide-like diuretic
Stage 4 - Consider adding spironolactone or a Beta blocker

Question 8

Suggest some possible ADRs of an angiotensin II receptor blocker (ARB)

Answer 8

• Hyperkalaemia
• Dizziness
• Headache

Less commonly - orthostatic hypotension & renal insufficiency

Question 9

Why are ACEi not as good for black people as people of other ethnicities?

Answer 9

In general they have a weaker RAAS system meaning the drug has less effect.

Question 10

Suggest some possible ADRs of ACEi.

Answer 10

• Dry cough (bradykinin build up)
• Hyperkalaemia
• Headaches & dizziness
• First-dose hypotension

Question 11

Which diuretics are mainly used in hypertension? Suggest some possible ADRs that can occur with them.

Answer 11

Thiazide-like diuretics, which has ADRs like:

• Hypokalaemia
• Gout
• Diabetes type 2

Question 12

What blood pressure is associated with a hypertensive emergency? Which drug should be administered?

Answer 12

A blood pressure of above 200/120mmHg is considered to be a hypertensive crisis. Give sodium nitroprusside which causes massive vasodilation.

Question 13

Suggest some possible ADRs of the dihydropyridine (nifedipine, amylodopine) class of CCBs.

Answer 13

• Reflex tachycardia
• Flushing
• Sweating

Question 14

Suggest some possible ADRs of the benzothiazepines (ditalazem) class of CCBs.

Answer 14

• Bradycardia

- Dizziness

Question 15

Suggest some possible ADRs of the phenylalkaline (verapamil) class of CCBs.

Answer 15

• Bradycardia

- Constipation