Hypertension

Question 1

what are the values for stage 1 hypertension?

Answer 1

clinic blood pressure 140/90 mmHg or higher

ABPM daytime average 135/85 mmHg or higher

Question 2

what are the values for stage 2 hypertension?

Answer 2

clinic blood pressure 160/100 mmHg or higher

ABPM daytime average 150/95 mmHg or higher

Question 3

what are the values for severe hypertension?

Answer 3

clinic systolic blood pressure is 180 mmHg or higher or diastolic blood pressure is 110 mmHg or higher

Question 4

how does the target blood pressure differ in patients aged over 80 years compared with those aged 55-80 years?

Answer 4

55-80 - target is <135/85

80+ - target is <145/85

Question 5

what is step 1 in antihypertensive treatment for people aged over 55 / black people of African or Caribbean family origin?

Answer 5

calcium channel blocker (CCB)

Question 6

in patients where a CCB is not suitable (oedema, intolerance) or there is evidence of heart failure or a high risk of heart failure, what is the alternative?

Answer 6

thiazide-like diuretic

Question 7

what is the first step in antihypertensive treatment for patients under the age of 55?

Answer 7

ace inhibitor / ARB

Question 8

what are the contraindications for ACEI / ARB?

Answer 8

afro-caribbean or women of child bearing age

Question 9

how do you treat resistant hypertension when the blood potassium level is <4.5 mmol/L?

Answer 9

consider further diuretic therapy with low dose spironolactone (25 mg once daily)

Question 10

how do you treat resistant hypertension when the blood potassium level is >4.5 mmol/L?

Answer 10

consider higher dose thiazide-like diuretic

Question 11

why should you exercise caution with certain patients when prescribing spironolactone?

Answer 11

people with a reduced estimated GFR may have an increased risk of hyperkalaemia

Question 12

give an example of an angiotensin converting enzyme inhibitor

Answer 12

ramipril

Question 13

what are the contraindications of prescribing ACEIs?

Answer 13

renal artery stenosis
renal failure
hyperkalaemia

Question 14

what are the adverse drug reactions associated with ACEIs?

Answer 14

cough
first dose hypotension
taste disturbance
renal impairment
angioneurotic oedema

Question 15

which other drugs do ACEIs interact with?

Answer 15

NSAIDs (precipitates acute renal failure)

potassium supplements / potassium sparing diuretics (hyperkalaemia)

Question 16

give an example of an angiotensin II antagonist

Answer 16

losartan
valsartan
candesartan
irbesartan

Question 17

what is an advantage of using an angiotensin II antagonist over an angiotensin converting enzyme inhibitor?

Answer 17

no cough

Question 18

give an example of a calcium channel blocker

Answer 18

amlodipine, felodipine (vasodilator)

verapamil, diltiazem (rate limiting)

Question 19

what are the contraindications of using calcium channel blockers?

Answer 19

acute MI

heart failure, bradycardia (rate limiting CCBs)

Question 20

what are the adverse drug reactions of calcium channel blockers?

Answer 20

flushing
headache
ankle oedema
indigestion and reflux oesophagitis
bradycardia, constipation (rate limiting)

Question 21

give an example of a thiazide type diuretic

Answer 21

indapamide

clortalidone

Question 22

what are the adverse drug reactions of thiazide type diuretics?

Answer 22

gout

impotence

Question 23

give an example of an alpha-adrenoceptor antagonist

Answer 23

doxazosin

Question 24

give an example of a centrally acting agent

Answer 24

methyldopa

moxonidine

Question 25

give an example of a vasodilator

Answer 25

hydralazine | minoxidil

Question 26

what are the adverse drug reactions of alpha-adrenoceptor antagonists?

Answer 26

first dose hypotension dizziness dry mouth headache

Question 27

what are the adverse drug reactions of centrally acting agents?

Answer 27

sedation and drowsiness dry mouth and nasal congestion orthostatic hypotension

Question 28

how do you treat hypertension in a woman of child bearing age (not yet pregnant)?

Answer 28

``` nifedipine mr (CCB) methyldopa (CAA) atenolol, labetalol (BB) ```

Question 29

how do you treat hypertension once a woman becomes pregnant?

Answer 29

add thiazide diuretic and / or amlodipine (CCB)

Question 30

how do you treat preeclampsia?

Answer 30

as previous plus IV hydralazine, esmolol, labetalol

Question 31

how do ACEIs work?

Answer 31

competitively inhibit the actions of angiotensin converting enzyme, which converts angiotensin I to angiotensin II, a potent vasoconstrictor and hypertrophogenic agent (wtv that means)

Question 32

how do ARBs work?

Answer 32

competitively block the actions of angiotensin II at the angiotensin AT1 receptor

Question 33

how do CCBs work?

Answer 33

blocking the L type calcium channels selectivity between vascular and cardiac L type channels relaxing large and small arteries and reducing peripheral resistance reducing cardiac output

Question 34

how do thiazide type diuretics work?

Answer 34

urinary excretion of sodium | resistance vessel dilatation

Question 35

how do alpha-adrenoceptor antagonists work?

Answer 35

selectively block post synaptic alpha1-adrenoceptors | oppose vascular smooth muscle contraction in arteries

Question 36

how do centrally acting agents work?

Answer 36

converted to alpha-methylnoradrenaline which acts on CNS alpha adrenoceptors which decrease central sympathetic outflow