Tutorial 16 - Hypertension

Question 1

What is hypertension?

Answer 1

Persistently raised blood pressure.

Question 2

What is the difference between primary and secondary hypertension?

Answer 2

• Primary - No identifiable cause - most common (90%).
• Secondary - Known cause - renal/endocrine/vascular cause.

Question 3

How can hypertension be staged?

Answer 3

• Stage 1 - Rangeing from 140/90 to 159/99
• Stage 2 - Rangeing from 160/100 to 179/119
• Stage 3 - Above 180/120

Question 4

What are the risk factors for hypertension?

Answer 4

• Increasing age
• Co - existing co-morbidities - diabetes or CKD.
• Lifestyle choices - smoking, alcohol, high salt diet.

Question 5

What are the possible complications of hypertension?

Answer 5

• Heart failure (left ventricular hypertrophy and consequent failure).
• Coronary heart disease and MI
• CKD
• Stroke
• Peripheral arterial disease
• Vascular dementia

Question 6

What is 1st line for patient below the age of 55,non afro carribean ethnicity and potentially have type 2 diabetes?

Answer 6

• ACEI -ramipril
• ARB - Candesartan

Question 7

What is 1st line for a patient who is over the age of 55 or are black/Caribbean ethnicity?

Question 8

How do ACEI and ARB’S work?

Answer 8

• They both ultimately work to decrease blood pressure by blocking the vasodilative and aldosterone secreting effects of AT2.
• ACEI - Block ACE
• ARBS- Block eeffect of AT2 at AT1 receptor.

Question 9

What are the possible side effects of ACEI/ARB’s?

Answer 9

• Hypotension
• Hyperkalaemia (muscle weakness,)
• Cough
• Angioedema
• Renal detoriation

Question 10

Contraindications for prescription of ACEI/ARB’As.

Answer 10

• Angioedema
• Renal disease i.e., renal artery stenosis.

Question 11

What is 1st line for a person over 55 and affro carribean ethnicity.

Answer 11

• CCB - amlodipine

Question 12

How does amlodipine work.

Answer 12

• Relaxes muscles around blood vessels and thereby increases its diameter - decreasing the blood pressure.

Question 13

What are the possible side effects of amlodipine?

Answer 13

• Peipheral oedema
• Tachcardyia
• flushing

Question 14

What are the contraindications for amlodipine?

Answer 14

• Cardiogenic shock

Question 15

What is done after these drug treatments?

Answer 15

• Mix and match ACEI with CCB
• Introduce thiazide like diuretics
• Introduce alpha blocker (ideal if they also have an enlarged prostate), beta blocker(ideal if they also have anxiety) or spironolactone.