Hypertension and Hyperlipidaemia

Question 1

What level is diagnostic of mild HTN?

Answer 1

140/90

Question 2

What level is diagnostic of moderate HTN?

Answer 2

160/100

Question 3

What level is diagnostic of severe HTN?

Answer 3

>180/110

Question 4

What are the risk factors for primary HTN?

Answer 4

Smoking

Diabetes

>Age

Obesity

FH

Previous MI

Alcohol intake

Male

Question 5

What percentage of HTN cases are primary?

Answer 5

90%

Question 6

What are the causes of secondary HTN?

Answer 6

Renal artery stenosis

Pre-Eclampsia

NSAIDS

Combined Contraceptive Pill

Cushing’s

Conn’s Disease

Co-Arctation of the aorta

Diabetes

Pregnancy

Pheochromocytoma

Question 7

When should secondary HTN be considered?

Answer 7

If patient is not responding to treatment

Question 8

What investigations are used in the diagnosis of HTN?

Answer 8

Repeat BP measurements over time

24 Ambulatory BP Monitoring

• White coat hypertension
• If BP inconclusive

Question 9

Name some complications of HTN

Answer 9

Stroke and cognitive decline

MI

HF

Renal failure/Proteinuria

Retinopathy

Question 10

What is the non-pharmacological management of HTN?

Answer 10

Weight loss

Diet

Question 11

What is the pharmacological management of HTN in >55 or Afro-Caribbeans?

Answer 11

CCB

CCB + ACEI/ARB (prefered ARB in African Carribean origin) or thiazide diuretic

ACEI + CCB + Thiazide diuretic

+ Low dose spirnolactone if K less than 4.5

or B/A blocker if K more than 4.5

Specialist review if not controlled on 4 drugs

Question 12

What is the pharmacological management of <55?

Answer 12

ACEI/ARB

ACEI + CCB or thiazide diuretic

ACEI + CCB + thiazide diuretic

+ Low dose spirnolactone if K less than 4.5

or B blocker if K more than 4.5

Specialised review if not controlled on 4 drugs

Question 13

What is the first line hypertensive medication in diabetics, regardless of age?

Answer 13

ACEI

Due to renoprotective effect

Question 14

What is the mechanism of action of ACEI?

Answer 14

Angiotensin converting enzyme inhibitor

Prevents angiotensin 1 converting to angiotensin 2

So less vasoconstriction

Also causes Na excretion and H2O release

Question 15

Give side effects of ACEI

Answer 15

Dry cough

Urticaria

Hyperkalaemia

Angioedema, resulting in swollen tongue and lips

First dose hypotension

Dizziness

Question 16

Give contraindications of ACEI

Answer 16

Pregnancy and breastfeeding

Renovascular disease, may result in renal impairment

Aortic stenosis, may result in hypotension

Hereditary of idiopathic angioedema

Question 17

What monitoring should be involved with ACEI?

Answer 17

Rise in creatinine and K should be expected

Significant renal impairment in patients with undiagnosed renal artery stenosis

Question 18

Give possible drug interactions with ACEI

Answer 18

High dose diuretic therapy, significantly increases hypotension risk

Question 19

What is the mechanism of action of CCB?

Answer 19

Reduce cell entry of Ca via voltage sensitive channels

As Ca causes contractions, reducing this leads to relaxation of muscles

Question 20

Give an example of a CCB

Answer 20

Amlodipine

Verapamil

Question 21

Give side effects of CCB

Answer 21

Ankle oedema

Flushes

Question 22

What is the mechanism of action of B Blockers?

Answer 22

Blocks adrenalin from reaching B1

So slows heart rate down

But can also block B2 in lungs

Question 23

Give side effects of B-Blockers

Answer 23

Cold peripheries

Bronchospasms, contraindicated in asthma

Bradycardia

Hypotension

Erectile dysfunction

Fatigue/sleep disturbance, including nightmares

Reduce hypoglycaemic awareness

Question 24

Give contraindications of B Blockers

Answer 24

Uncontrolled heart failure

Asthma

Sick sinus syndrome

Concurrent verapamil use, may precipitate severe bradycardia

Question 25

What is the mechanism of action of thiazide diuretics?

Answer 25

Inhibit the sodium/chloride co-transporter

Question 26

Give an example of a thiazide diuretic

Answer 26

Bendroflumethiazide Indapamide

Question 27

Give side effects of thiazaide diuretics

Answer 27

Postural hypotension **Hypokalaemia,** causing heart block **Hyponatraemia** **Hypercalcaemia,** causing constipation, renal stones **Impaired glucose tolerance** **Impotence/sexual dysfunction** Agranulocytosis Dehydration Gout Photosensitivity rash Pancreatitis, rare complication **Precipitate digoxin toxicity**

Question 28

What is malignant hypertension?

Answer 28

Medical emergency involving fibrinoid necrosis of arterioles and dilation of cerebral arteries

Question 29

Describe the presentation of malignant HTN

Answer 29

Headache Vomiting Visual disturbance Convulsions Papilloedema

Question 30

What is the management of malignant HTN?

Answer 30

IV Labetalol

Question 31

Name some complications of malignant HTN

Answer 31

Microangiopathic haemolytic anaemia Renal failure Cerebral haemorrhage Coma Death

Question 32

What is hyperlipidaemia/dyslipidaemia?

Answer 32

Raised levels of cholesterol and triglycerides within the blood, associated with increased cardiovascular risk

Question 33

What is familial hypercholesterolaemia?

Answer 33

Autosominal dominant elevation of cholesterol, leading to earlier development of cardiovascular disease

Question 34

How does hyerlipidaemia present?

Answer 34

Tendon xanthomata Xanethelasma

Question 35

What is orthostatic hypotension?

Answer 35

Diagnosed when there is a drop in systolic BP of at least 20 mmHg and/or a drop in diastolic BP of at least 10 mmHg after 3 minutes of standing

Question 36

What can be used in the management of orthostatic hypotension?

Answer 36

Advise patient to stand slowly, dorsiflexing the feet before standing upiright Fludrocortisone, first line drug Midodrine