CSB601 Chap.5 Hypertension and Dyslipidaemia
Hypertension and Dyslipidaemia
Blood pressure decisions and lipid targets
This chapter covers the Week 4 cardiovascular content on raised blood pressure and cholesterol.
It follows the decision path from diagnosis on repeated readings and five-year absolute risk, through the three first-line antihypertensive classes and the logic of combining complementary mechanisms, to the safety checks that accompany ACE inhibitors, sartans, calcium channel blockers, thiazides and statins.
Where marks come from in Week 4 cases
Workshop cases ask you to explain absolute risk to a patient whose reading looks acceptable, find gaps such as missing lipid therapy, and counsel on modified-release products.
The final exam is closed book and mostly multiple choice, so class names, suffixes and adverse effects must be recalled without notes.
What this chapter covers
- 01
Absolute Cardiovascular Risk
- 02
First-Line Antihypertensive Classes
- 03
Combination Therapy Logic
- 04
ACE Inhibitor and Sartan Safety
- 05
Statins and Ezetimibe
- 06
Lifestyle Before Lipid Drugs
Worked example · free
Three safety checks after an ACE inhibitor start
- 2Potassium: an ACE inhibitor reduces aldosterone and can push serum potassium up, so the supplement stops unless the prescriber specifically wants it, and renal function and electrolytes are rechecked one to two weeks after the start.
- 2NSAID: daily ibuprofen is reviewed when an ACE inhibitor begins, because NSAIDs feature among its interaction cautions and, if a diuretic were ever added, would complete the combination that threatens kidney function. Paracetamol is the simpler analgesic to discuss.
- 2Dizziness: hypotension and dizziness are common early effects, so counsel him to rise slowly from sitting or lying and to sit down if light-headed, and confirm that a low starting dose was used.
Key terms
- Absolute Cardiovascular Risk
- The estimated probability that a person will have a cardiovascular event such as a heart attack or stroke within the next five years.
- Dihydropyridine Calcium Channel Blocker
- A calcium channel blocker, such as amlodipine or felodipine, that acts mainly on arteriolar smooth muscle to lower vascular resistance.
- HMG-CoA Reductase
- The rate-limiting enzyme of cholesterol synthesis in the liver and the enzyme that statins inhibit.
- Statin-Associated Muscle Symptoms
- Muscle pain, tenderness or weakness linked to statin therapy, at the severe end including myopathy and rhabdomyolysis.
Hypertension and Dyslipidaemia FAQ
Is a thiazide only a first choice for people aged 65 and over?
Teaching materials differ here. The 2023 hypertension lecture lists a low-dose thiazide as a first consideration for people 65 or older, whereas the 2026 workshop answer key places thiazide and thiazide-like diuretics among first-line options with no age limit. In an exam answer, give the full class list and mention the lecture's age qualifier so either reading is covered.
Why might a doctor add a second blood pressure tablet instead of increasing the first?
Raised blood pressure usually has several drivers working together, including renin-angiotensin activity, vessel tone and salt retention. A second class aimed at a different driver tends to lower pressure further than a higher dose of the first drug. The hypertension lecture makes this point for sartans, preferring a thiazide add-on, and the workshop pairs an ACE inhibitor with a calcium channel blocker.
What blood tests should be done before starting a statin?
Teaching slides list liver function, specifically aminotransferase levels, and a baseline creatine kinase, followed by attention to muscle symptoms during treatment. Raised aminotransferases are dose dependent and usually respond to a lower dose. Myopathy is more likely in older or frail people, at high doses, with kidney or liver disease and with interacting medicines, so these factors set how closely to watch.
When is ezetimibe used instead of or alongside a statin?
Ezetimibe reduces cholesterol absorption from food and bile in the gut, complementing the liver-based action of a statin. It is usually added to a statin when LDL cholesterol stays above target, and used alone only when a statin cannot be tolerated. Avoid it with fibrates, in moderate hepatic impairment and in people with pancreatitis or gallbladder disease.
Exam move
Start by drawing the blood pressure decision from memory: when drug treatment begins immediately, the three first-line classes, the target below 140/90 mmHg and the add-a-class step. Then build a one-line card for each class with its suffix (pril, sartan, dipine), mechanism, two common adverse effects and one counselling sentence, because the closed-book multiple choice section rewards fast recall of exactly these details.
Practise explaining absolute risk aloud to an imaginary patient whose reading sits just under target, since workshop cases repeatedly test that conversation. For lipids, rehearse the statin monitoring trio of liver enzymes, creatine kinase and muscle symptoms, and the dark urine warning.
Finish each session by writing one short answer that combines a medicine change with a lifestyle change and a monitoring step, and time yourself at about one minute per mark.
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