Hypertension Therapy

Question 1

Stepped Approach to treat hypertension

Answer 1

1. Identify true hypertension
2. Assess the risk
3. Set a blood pressure target to be obtained

Question 2

BHS guidelines for treating hypertension in the young and elderly

Answer 2

YOUNG (high renin) - ACEI/ARB

ELDERLY (low renin) - CCB/TTD

Question 3

Indications for treatment for people with stage 1 hypertension

Answer 3

People under aged 80 with ABPM of > 135/85 with one or more of the following
- target organ damage
- established CV disease
- Renal disease
- Diabetes
- 10yr CVS risk of 20% or greater
People aged under 40
- Seek specialist evaluation for secondary causes and for a more detailed assessment of organ damage

Question 4

Indications for treatment in people with stage 2 hypertension

Answer 4

Offer people of any age treatment

Question 5

ACE inhibitors

Answer 5

Ramipril

Perindopril

Question 6

ACEI contraindications

Answer 6

Renal artery stenosis
Renal failure
Hyperkalaemia

Question 7

ACEI adverse drug reactions

Answer 7

Cough 
First dose hypertension
Taste disturbance
Renal impairment 
Angioneurotic oedema

Question 8

ACEI drug-drug interactions

Answer 8

NSAIDs
K supplements
K sparing diuretics

Question 9

ARBs (angiotensin II receptor blockers)

Answer 9

Losartan
Valsartan
Candesartan
Irebesartan

Question 10

Calcium Channel Blockers

Answer 10

Vasodilators
- Amlodipine
- Felodipine 
Rate limiting
- Verapramil 
- Diltiazem

Question 11

CCBs contraindications

Answer 11

Acute MI

Heart failure, bradycardia (rate limiting CCBs)

Question 12

CCBs Adverse Drug reactions

Answer 12

Flushing
Headache
Ankle oedema
Indigestion and reflux oesophagitis

Question 13

Rate limiting CCBs can also cause…

Answer 13

Bradycardia

Constipation

Question 14

Thiazide Type Diuretics

Answer 14

Indapamide

Clortalidone

Question 15

TTDs adverse drug reactions

Answer 15

Gout
Incompetence
Not common

Question 16

Less commonly used agents for treatment of hypertension

Answer 16

1. Alpha-adrenoreceptor antagonists e.g. Doxazosin - can cause HF
2. Centrally acting agents e.g. methyldopa - can cause depression
3. Vasodilators e.g. minoxidil - can cause dry mouth and bad dreams

Question 17

Hypertension therapy during pregnancy

Answer 17

NOT ACEI/ARBs
Pre-pregnancy:
- Nifedipine MODIFIED RELEASE
- Atenolol (not licenced)
- Methyldopa (can cause depression)
- Labetalol
Pregnancy:
- Add TTD and/or amlodipine
- (As above and IV esmolol, labetalol, hydralazine)