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Cardiology Quiz Practice MCQ
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Q1- A 65-year-old hypertensive non-diabetic has
an eGFR lt40. Screening tests showed
microalbuminuria and a normal renal ultrasound.
Which class of antihypertensive medication should
you instigate? a) ACE inhibitor b) Beta-blocker c)
Calcium-channel blocker d) Thiazide diuretic
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Ans1 A- The control of blood pressure and
blocking of the renin?angiotensin system are
essential to preserve renal function. The African
American Study of Kidney Disease (AASK) showed
that ACE inhibitors were better at slowing eGFR
decline than beta-blockers or calcium-channel
blockers. This is true of diabetic and
non-diabetic patients, especially if there is
evidence of proteinuria. Optimal BP control is
lt130/80 mmHgor lt125/75 mmHg in the instance of
proteinuria. It is likely that the benefits of
renin? angiotensin blockage are additional to the
benefits derived from absolute blood pressure
reduction.
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Q2- The side effects of the broad spectrum of
calcium-channel blockers (CCBs) include the
following, except a) Peripheral oedema b) Gum
hypertrophy c) Dyslipidaemia d) Negatively
ionotropic
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Ans 2- C- Peripheral oedema is caused by
pre-capillary dilatation and, as with gum
hypertrophy, occurs mostly in dihydropyridines.
CCBs are negatively ionotropic and should be
avoided in left ventricular dysfunction. Beta
blockers rather than CCBs cause dyslipidaemia,
reducing HDL and increasing triglycerides.
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Q3- The following is true of hypertension in the
elderly, except a) There is an age-associated
increase in systolic blood pressure
(SBP) b) There is decreased variability in blood
pressure c) Beta-blocker use should be limited to
specific indications d) There is good evidence
for the treatment of hypertension in the very
elderly (gt80 years)
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Ans - B- SBP increases with age whereas DBP
plateaus at about age 60 resulting in an
increased pulse pressure. The elderly have
increased variability in their BP, and so several
measurements should be made before diagnosis.
Beta-blockers should be used in specific
circumstances, such as with associated heart
failure or CHD, as thiazide diuretics and ACE
inhibitors have been shown to be more effective.
The Hypertension in the Very Elderly Trial
(HYVET) compared indapamide and perindopril
treatment versus placebo for patients over the
age of 80 with a SBP gt160 mmHg. The treatment
group had a significant reduction in stroke,
mortality (stroke, cardiovascular, and
all-cause), and heart failure.
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