management and treatment

Question 1

target clinical blood pressure for

1) <80 y/o with treated hypertension
2) ≥80 y/o with treated hypertension

Answer 1

1) below 140/90

2) below 150/90

Question 2

target AMPB or HBPM for

1) <80 y/o with treated hypertension
2) ≥80 y/o with treated hypertension

Answer 2

target average blood pressure of during the person’s waking hours of:

1) <135/85
2) <145/85

Question 3

how should the treatment offered differ between someone with isolated systolic hypertension and someone with raised systolic AND diastolic BP?

Answer 3

they should be given the same treatment

Question 4

what 2 drugs should you never combine to treater hypertension?

Answer 4

an ACE inhibitor and an ARB

Question 5

True or false: people aged 80 years and over should be offered the same antihypertensive drug treatment as people aged 55–80 years

Answer 5

true (taking into account any comorbidities)

Question 6

first step for hypertension treatment in a <55

Answer 6

ACEI or low-cost ARB (angiotensin II receptor blocker)

Question 7

first step for hypertension treatment in a >55 / black person of African or Caribbean family origin of any age with hypertension

Answer 7

calcium-channel blocker

Question 8

step 2 for treating hypertension (irregardless of age/ colour)

Answer 8

ACEI or ARB + calcium channel blocker

Question 9

step 3 for treating hypertension (irregardless of age/ colour)

Answer 9

ACEI or ARB + calcium channel blocker + thiazide-like diuretic (each taken once daily)

Question 10

at which stage in the NICE treatment plan for hypertension are you treating resistant hypertension?

Answer 10

stage 4

Question 11

give an example of a thiazide-like diuretic

Answer 11

chlortalidone

Question 12

What is resistant hypertension?

Answer 12

clinic blood pressure that remains higher than 140/90 mmHg after treatment with the optimal or best tolerated doses of an ACE inhibitor or an ARB plus a CCB plus a diuretic

Question 13

In what case may an ARB be offered over an ACEI?

Answer 13

If the patient found the dry cough produced as a side effect of ACEI intolerable

Question 14

True or false: Beta-blockers are a preferred initial therapy for hypertension.

Answer 14

false - beta-blockers are NOT a preferred initial therapy for hypertension (but may be considered in same situations)

Question 15

In what situation would the use of beta-blockers in treatment of hypertension be considered?

Answer 15

It may be considered in younger people, particularly:

• those with an intolerance or contraindication to ACE inhibitors and angiotensin II receptor antagonists or
• women of child-bearing potential or
• people with evidence of increased sympathetic drive.

Question 16

A calcium channel blocker (CCB) is the first stage treatment for >55s or black patients from African or Caribbean family origin of any age with hypertension. What would be alternatively prescribed if this was not suitable? and why might it not be suitable to prescribe this to a patient?

Answer 16

If a CCB is not suitable, for example because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.

Question 17

If therapy is initiated with a beta-blocker and a second drug is required, what should you add instead of a thiazide-like diuretic and why?

Answer 17

a CCB

to reduce the person’s risk of developing diabetes.

Question 18

downside to measuring BP in clinic?

Answer 18

it can lead to white coat hypertension

Question 19

how might the effects of white coat hypertension be avoided so as to better predict the actual BP of the patient

Answer 19

offer ABPM or HBPM

Question 20

patients with sustained BP are subdivided into which 2 groups?

Answer 20

stage 1 and stage 2 hypertension

Question 21

define stage 1 and stage 2 hypertension

Answer 21

??

Question 22

what AMBP and HBPM recordings would diagnose

1) stage 1 hypertension
2) stage 2 hypertension

Answer 22

1) ABPM daytime average and HBPM average of 135/85

2) ABPM daytime average and HBPM average of 150/95

Question 23

what ECG features would suggest ischaemia or previous infarct

Answer 23

pathological Q wave, left bundle branch block

Question 24

when a patient present with angina what should be done in terms of blood tests? (ideally initial blood tests should be done within a day of presentation)

Answer 24

a full blood count to exclude anaemia, renal function,

fasting blood glucose and fasting lipid profile.

Question 25

What investigative technique should be deployed if there is clinical suspicion of an arrhythmia or a
murmur (such as aortic stenosis)?

Answer 25

a 24-hour tape or echocardiogram may be indicated.

Question 26

anything that ends in 
1) sartan
2) pril
3) lol
4) dipine (some kinds of \_\_\_\_\_)
are what kind of drugs

Answer 26

1) ARB
2) ACE inhibitor
3) beta-blocker
4) some kinds of CCB