Clinical Scenario Flashcards: Hypertension & Antihypertensives (Paramedic-Focused)

What is the recommended treatment target for a 52-year-old patient with hypertension and BP of 148/92 mmHg?

<140/90 mmHg (or lower if tolerated)

Why is achieving BP control important in patients with hypertension?

Reduces cardiovascular morbidity and mortality, and microvascular complications (brain, kidneys, retina)

What is the key principle regarding antihypertensive drugs?

BP reduction is more important than the specific drug class in reducing cardiovascular events

Why is it appropriate for a 60-year-old with hypertension and diabetic nephropathy to be on an ACE inhibitor?

ACE inhibitors are first-line in chronic kidney disease and diabetes with albuminuria

What is the rationale for prescribing an ACE inhibitor to a post-MI patient with LV dysfunction?

Reduces mortality and supports cardiac function

What alternative may be prescribed for a patient reporting a persistent cough on an ACE inhibitor?

Sartans (ARBs)

What class is amlodipine and why is it used for hypertension?

Dihydropyridine calcium channel blocker; first-line antihypertensive

What major benefit do calcium channel blockers provide?

Reduced risk of stroke

What important risk should paramedics be aware of with calcium channel blockers?

Increased risk of heart failure

Why is it concerning for a patient with known heart failure to take verapamil?

Verapamil is contraindicated in heart failure

Are any calcium channel blockers safer in heart failure?

Dihydropyridines may be used cautiously

Why is a thiazide diuretic appropriate for a 72-year-old patient?

First-line treatment in patients >65 years

What should be monitored in patients on thiazides?

Risk of new-onset diabetes

Why are thiazides not preferred as first-line monotherapy in younger patients?

Increased risk of developing diabetes

Why is a beta-blocker prescribed for a hypertensive patient with angina?

Beta-blockers are indicated when compelling conditions (e.g., angina) exist

Why are beta-blockers less preferred for primary hypertension alone?

Less effective at reducing stroke and increased diabetes risk

What should you know about alpha-blockers for hypertension?

Limited evidence for reducing cardiovascular morbidity/mortality

Why is medication recognition important for a patient taking multiple antihypertensives?

Helps identify comorbidities, guide risk assessment, and anticipate complications (e.g., hypotension)

What contributing factor should be considered if a hypertensive patient becomes hypotensive after GTN administration?

Concurrent antihypertensive medications increasing hypotensive effect

Why is understanding antihypertensives important in prehospital care?

Guides clinical interpretation, identifies underlying disease, predicts adverse effects and drug interactions