Question 21 -
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ACEIs used for hypertension, post MI, for heart failure.
Streptokinase used in STEMI.
Question 22 -
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ACEIs are very useful in diabetics as they decrease intraglomerular pressure, reducing renal damage. Reducing BP reduces microalbuminuria and attenuates loss of GFR. ACEIs redure microalbuminuria and slow progression to CRF even if normotensive.
Beta-blockers not generally used in diabetics (altho not absolutely contra-indicated)
Question 23 -
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Non-pharm management NB for all hypertension.
Beta-blockers are diabetogenic and therefore not recommended for use.
New recommendations for HTN rx: <55 1st choice is ACEI, >55 or blacks a Thiazide diuretic or calcium channel blocker. No mention of contra-indication with hyperlipidaemia in BNF.
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