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Hypertension Management and Treatment
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Hypertension Management and Treatment
Hypertension Management and Treatment
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1
Question
What is the recommended dosage of Spironolactone for patients with severe heart failure or post myocardial infarction?
Answer
25 mg po per day; consider increasing to 50 mg/day for patients with high dose furosemide and hypokalemia.
2
Question
What precautions should be taken when administering Spironolactone?
Answer
Caution should be taken regarding renal function and increased potassium levels.
3
Question
What types of diuretics are recommended for patients with congestion?
Answer
Loop diuretics (e.g., Lasix/furosemide) and Thiazide (HCT) diuretics.
4
Question
What is the initial dose range for loop diuretics (Lasix/furosemide)?
Answer
20 mg/day up to 100-120 mg TID/QID, preferably keeping a low dose.
5
Question
What should be monitored in patients on diuretics?
Answer
Electrolytes (Na, K, Cl) and renal function (BUN, Cr).
6
Question
What are the potential side effects of Digoxin?
Answer
Caution in renal failure, hypokalemia, and rheumatic heart disease.
7
Question
What is the recommended dosage for Digoxin in the treatment of heart failure?
Answer
0.125 - 0.25 mg per day.
8
Question
What should be assessed during follow-up visits for heart failure patients?
Answer
Assess symptoms, functional status, adherence, medication tolerance, physical examination (PE), vital signs (VS), signs of heart failure, and precordial exam.
9
Question
What laboratory investigations should be conducted during follow-up visits for heart failure patients?
Answer
Creatinine (Cr), Blood Urea Nitrogen (BUN), Potassium (K), and Sodium (Na) as appropriate.
10
Question
When should the doses of ACE inhibitors (ACEIs) and beta-blockers (BBs) be escalated?
Answer
If there is no problem with adherence to treatment and lifestyle modifications.
11
Question
What additional therapies may be considered if a patient is not improving after optimal treatment with diuretics, ACEIs, and BBs?
Answer
Consider adding spironolactone or digoxin.
12
Question
What is the prevalence of hypertension in Ethiopia according to the WHO STEPS survey?
Answer
16%.
13
Question
What are the consequences of untreated hypertension?
Answer
It significantly increases the risks of heart, brain, kidney, and other diseases.
14
Question
What are the key risk factors for hypertension?
Answer
Prior heart attack or stroke, diabetes, chronic kidney disease (CKD), obesity, tobacco use, and family history of heart attack or stroke.
15
Question
What should be done when measuring blood pressure?
Answer
Use the appropriate cuff size, measure on both arms initially, ensure the patient is relaxed and sitting properly, and take at least two readings.
16
Question
What is the recommended method for measuring blood pressure?
Answer
Blood pressure can be measured by a conventional sphygmomanometer with a stethoscope or by an automated electronic device.
17
Question
What is the definition of hypertension based on blood pressure measurements?
Answer
Hypertension is diagnosed if, on two visits on different days, the systolic blood pressure is 140 mmHg or higher, or the diastolic blood pressure is 90 mmHg or higher.
18
Question
What is the protocol for diagnosing hypertension?
Answer
The diagnosis should be confirmed at an additional patient visit, usually 1 to 4 weeks after the first measurement.
19
Question
What are the mandatory tests at diagnosis of hypertension?
Answer
Urine dipstick to check for protein and creatinine to check for renal function.
20
Question
What are optional tests at diagnosis for patients with hypertension?
Answer
ECG to assess heart effects, serum electrolytes (mainly potassium), and thyroid function tests.
21
Question
What lifestyle modifications should be recommended for hypertension management?
Answer
Healthy diet, physical activity, tobacco cessation, and limiting alcohol use.
22
Question
What are the treatment targets for hypertension?
Answer
Blood pressure is controlled when SBP is 140 mmHg and DBP is 90 mmHg.
23
Question
When should pharmacologic treatment be initiated for hypertension?
Answer
For patients who cannot achieve target blood pressure with lifestyle interventions, or at initial presentation in those with end-organ damage or high WHO cardiovascular risk.
24
Question
What should be done if lifestyle interventions fail in treating uncomplicated grade 1 hypertension?
Answer
If lifestyle interventions fail after three months, consider initiating medications.
25
Question
What are the essential tests to assess cardiovascular risk for hypertension patients?
Answer
Blood sugar and cholesterol levels should be assessed to evaluate cardiovascular risk.
26
Question
What are the mandatory tests at diagnosis for hypertension?
Answer
Urine dipstick to check for protein, Creatinine to check for renal function.
27
Question
What are the optional tests at diagnosis for hypertension?
Answer
ECG to look for effect of blood pressure on the heart, Serum electrolytes mainly potassium, Thyroid function test to assess a secondary cause of hypertension.
28
Question
What are the indication-based tests for hypertension?
Answer
Echocardiography for heart failure patients, brain imaging for suspicion of stroke.
29
Question
What tests should be conducted for comorbidity and risk factor assessment in hypertension?
Answer
Blood sugar and cholesterol.
30
Question
What are the history risk factors for hypertension?
Answer
Smoking, excess salt intake, sedentary life, low fruit and vegetable intake, excess alcohol consumption.