Hypertension Management

Question 1

BC Guidelines

Desirable BP depends on:

Answer 1

• age
• end organ damage
• CV risk
• CV risk factors
• pt preference
• adherence to meds

Question 2

BC Guidelines

Desirable BP in general for adults with no comorbid conditions/DM/CKD/end organ damage

Desirable BP for adults 60+:

Answer 2

AOBP <135/85

60+ AOBP <145/85

Question 3

BC Guidelines

First line intervention for high risk normal, stage I and II HTN with <15% CV risk

Answer 3

health behaviour modifications!

-WEADSS
weight reduction
exercise
alcohol
diet
smoking 
stress

Question 4

Health Behaviour Recommendations:
WEADSS

Weight reduction:
Exercise:
Alcohol:
Diet:
Smoking:
Stress:

Answer 4

Weight: BMI 18.5-24.9
WC <102 men, <88 women

Exercise: 30-60 min mod intensity 4-7 days/week

Alcohol: <2 / day

Diet: DASH, salt <2g / day

Smoking: STOP

Stress: CBT

Question 5

HTN Canada

BP threshold to start anti-hypertensives

• high risk:
• DM:
• mod to high risk (CV or TOD):
• low risk (no CV or TOD):

Answer 5

high risk:
SBP 130+ (DBP does not matter)

DM: SBP 130+, DBP 80+

Mod-high risk: SBP 140+, DBP 90+

Low risk: SBP 160+, DBP 100+

Question 6

Hydrochlorothiazide:

first line for:

MoA

Answer 6

first line:
diabetes WITHOUT complications/CV risk factors (alternative to ACE-I/ARB)

MoA: inhibits Na reabsorption in DCT (excrete Na, K, water)

Question 7

Hydrochlorothiazide:

Common side effects:

Contraindications:

Precautions:

Answer 7

S/e:

• lytes abnormal
• gout/renal calculi
• photosensitivity
• 4x risk skin cancer

CI:
-anuria

Precautions:

• predisposed to gout or renal impairment
• use in 65+ may trigger SIADH

Question 8

Ramipril (ACE-I)

First line:

MoA:

Answer 8

first line DM with or without microalbuminuria/CKD/CVD/CVD risk factors

• non-diabetic CKD
• CAD
• CVD
• HF

MoA: stops conversion of angiotensin I to angiotensin II

Question 9

ACE-I

Side effects:

• serious
• common

Contraindications (3):

Monitor:

Answer 9

Side effects:

serious: angioedema, cholestatic jaundice, neutropenia/thrombocytopenia
common: cough, headache, dizziness

Contraindications:

• pregnancy
• hx angioedema
• bilateral renal artery stenosis

Monitor: CBC, lytes and LFTs before starting, 1 week after, monthly for first 3 months

Question 10

CCB eg amlodipine

Recommended for pts with:

MoA:

Answer 10

good for pts with LV dysfunction and CHF

MoA: blocks influx of calcium to prolong arterial smooth muscle relaxation

• reduces contractility
• decreases SA/AV node conduction

Question 11

CCB eg amlodipine

Common side effects:

Contraindications:

Precautions:

Answer 11

Side effects:

• dizziness
• fatigue
• dry mouth
• derm: photosensitivity, facial telangectasia

Contraindications:
-after MI, unstable angina

Precautions: CYP
Monitor LFTs