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2. Cardiovascular System > 18. Hypertension Therapy > Flashcards

18. Hypertension Therapy Flashcards

1
Q

What type of hypertension always needs to be identified?

A

TRUE hypertension;

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2
Q

What are 2 types of blood pressure monitoring methods for diagnosing hypertension

A
  1. ABPM; ambulatory blood pressure monitoring

2. HBPM Home Blood Pressure Monitoring

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3
Q

Why is ABPM the “gold standard” and the preferred method for measuring blood pressure?

A
  • patient’s can’t ignore bad signs
  • 24 hour readings taken even during night
  • gives more correlation and more accurate readings
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4
Q

What must the clinical BP and average ABPM daytime readings be like to diagnose STAGE 1 hypertension?

A
  • clinical BP; 140/90mmHg or higher

- ABPM daytime average: 135/85mmHg or higher

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5
Q

What must the clinical BP and average ABPM daytime readings be like to diagnose STAGE 2 hypertension?

A
  • clinical BP is 160/100mmHg or higher

- ABPM daytime average; 150/95mmHg or higher

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6
Q

What must the systolic and diastolic pressures be like to diagnose SEVERE hypertension?

A
  • clinical systolic BP; 180mmHg or higher

- clinical diastolic BP; 110mmHg or higher

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7
Q

Why are patients commonly given treatment for hypertension at night?

A

to prevent dip in pressure

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8
Q

When is it common for patients’ BP rise exponentially? (becomes sky high)

A

just before death (when symptoms become worse if acutely unwell and mistreated)

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9
Q

What are risk factors for hypertension? (6)

A
  1. previous Mi, stroke or ischaemic heart disease
  2. smoking
  3. diabetes mellitus
  4. hypercholesterolaemia
  5. family history
  6. physical examination
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10
Q

What tests are done to assess end organ damage due to hypertension and for what end-organ damage cause are they used for? (5)

A
  1. ECG (for left ventricular hypertrophy)
  2. echocardiogram (for left ventricular hypertrophy)
  3. ACR; albumin/creatine ratio (for proteinuria)
  4. Kidney (renal ultrasound)
  5. renal function (eGFR; estimated glomerular filtration rate)
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11
Q

What treatable causes should hypertensive patients be screened for? (4)

A
  1. renal artery stenosis/ FMD
  2. Cushing’s syndrome
  3. Conn’s syndrome
  4. sleep apnoea
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12
Q

What 3 things should be assessed in hypertensive patients at the start?

A
  1. assess risk
  2. assess end organ damage
  3. screen for treatable causes
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13
Q

What is the most common cause of left ventricular hypertrophy?(thickening of ventricular wall)

A

high BP (hypertension)

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14
Q

Because it’s difficult to assess hypertension risk, what is used to calculate the risk?

A

assign risk calculator/ Q-risk

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15
Q

What needs to be established once risk assessed?

A

a set target of BP needs to be obtained

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16
Q

What is recommended to be the target pressure?

A

<135/80-85mmHg (target that is aimed for; below it is normal theoretically)

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17
Q

At what CV disease risk should hypertension treatment be started?

A

at risk of 20%/10 years

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18
Q

Why are younger women especially treated straight away for hypertension?

A
  • if patient untreated, symptoms will worsen and damage will be done
  • increase risk by 30% for pre-eclampsia in women during if pregnant
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19
Q

At how many weeks of gestation does pre-eclampsia usually occur?

A

after 20 weeks

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20
Q

Why is hypertension treated? (2)

A
  • reduces cerebrovascular disease (ie stroke) by 40-50%

- reduces MI risk by 16-30%

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21
Q

How is hypertension GENERALLY treated? (what is the approach?)

A
  • stepped approach (one drug introduced… then next..then next) of several drugs
  • always LESS than maximum dose used
  • add new medication to current therapy until target BP is achieved
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22
Q

What should the drug dosage be for hypertension treatment? Why?

A

use LOW doses of several drugs; decreases and minimises adverse events and maximises patient compliance (if max dose used straight away then max. side effects)

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23
Q

Can antihypertensive drugs be continuously changed during treatment of hypertension?

A

NO; they should not be continuously changed

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24
Q

New drugs are added to existing/current therapy until when?

A

until the target BP is achieved

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25
Q

What treatment should be administered to young people with hypertension?

A

ACE inhibitor/ ARB (angiotensin II receptor blockers)

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26
Q

What 2 treatments should be administered to elderly (over 55) with hypertension?

A
  1. calcium channel blocker

2. thiazide-type diuretic

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27
Q

What are the levels of renin like in young and elderly?

A
  • high renin in young

- low renin in elderly

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28
Q

On what group of people should ACE inhibitors NEVER be used?

A

on women of child bearing age in they become pregnant; since ACE inhibitors are teratogenic (disrupts development of foetus)

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29
Q

What patients with stage 1 hypertension are offered antihypertensive drug treatment

A
  • antihypertensive drug treatment offered to people <80 years with ABPM (ambulatory BP monitoring) >135/85
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30
Q

Patients with stage 1 hypertension usually suffer from which conditions that can be targeted in treatment? (5)

A
  1. target organ damage
  2. established CV disease
  3. renal disease
  4. diabetes
  5. a 10 year CV risk equivalent to 20% or greater
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31
Q

What is the ABPM for stage 2 hypertension?

A

ABPM>150/95

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32
Q

What age group is offered stage 2 antihypertension treatment?

A

people of any age with stage 2 hypertension

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33
Q

What to do for people under age of 40 with stage 1 hypertension or greater? (2)

A
  1. seek specialist evaluation of secondary causes of hypertension
  2. more detailed assessment of potential target organ damage
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34
Q

What treatment to offer people aged 80+ years with hypertension?

A

Offer the SAME antihypertensive drug treatment as people aged 55-80 years taking account any co-morbidities

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35
Q

What is blood pressure target for people aged 80+ years?

A

BP target is different; <145/85

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36
Q

Why is target set much higher for people aged 80+ years?

A

Decreases risk of sudden BP drop if target is set slightly higher caused by antihypertensive drugs which can cause older people to fall and injure themselves due to sudden pressure drop so increases quality of life in the end

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37
Q

What monitoring technique is best for detecting patients with “white coat syndrome”?

A

ABPM; ambulatory blood pressure monitoring (but HBPM also used)

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38
Q

What is the step 1 treatment for hypertension in people OVER 55? (2)

A
  1. offer step 1 antihypertensive treatment with calcium channel blocker (CCB) to people aged over 55 and of Afro-Carribean origin
  2. If CCB not suitable, thiazide-like diuretic is used
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39
Q

When is thiazide- like diuretic offered? (2)

A
  • if CCB (ca channel blocker) not suitable due to oedema and intolerance
  • if evidence of heart failure or high risk of heart failure
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40
Q

What is step 1 treatment for hypertension in people UNDER 55?

A

ACEI/ARB (ACE: angiotensin- converting enzyme inhibitor and ARB: angiotensin receptor blockers)

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41
Q

Which 2 groups should NOT be offered ACEI/ ARB treatment?

A
  1. Afro-Carribean ethnicity

2. women of child bearing age

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42
Q

What is step 2 for treating hypertension?

A

Add thiazide- type diuretic such as clortalidone or indapamide to CCB or ACEI/ARB

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43
Q

What are 2 common thiazide- type diuretics used as step 2 for treating hypertension?

A
  1. clortalidone

2. indapamide

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44
Q

What is step 3 for treating hypertension?

A

Add CCB, ACEI/ARB and diuretic all together

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45
Q

What is step 4 for treating hypertension if blood K level is 4.5 mmol/l or lower? (this is a case for RESISTANT hypertension)

A

consider further diuretic therapy with low dose spironolactone (25mg once daily) if the blood K level is 4.5mmol/l or LOWER

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46
Q

What is step 4 for treating hypertension if blood K level is higher than 4.5 mmol/l?

A

Consider high dose thiazide-like diuretic treatment if the blood K level is higher than 4.5 mmol/l

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47
Q

What group of people should caution be taken when undertaking step 4 treatment for hypertension?

A

people with reduced estimated GFR (glomerular filtration rate) because they have an increased risk of hyperkalaemia

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48
Q

If there are no contraindications, according to what should treatment always be started/administered? (2)

A

according to:

  1. age
  2. other pathology
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49
Q

What is the treatment that should be generally used to treat hypertension in people over 55?

A

calcium channel blocker (CCB)

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50
Q

What is the treatment that should be generally used to treat hypertension in people less than 55?

A
  • an ACEI/ARB

- if single agent doesn’t control BP then use two together

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51
Q

What are 2 common ACEI (angiotensin converting enzyme inhibitors) used for treating hypertension?

A
  1. RAMIPRIL

2. Perindopril

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52
Q

Describe the action of ACEI drugs.

A
  • competitively inhibit the actions of angiotensin converting enzyme (ACE)
  • ACE converts angiotensin I to angiotensin II
  • Angiotensin II is a potent vasoconstrictor and hypertrophogenic agent (increases BP) so is stopped by ACEI
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53
Q

Angiotensin II plays a central role in organ damage of primarily which organs/structures? (4)

A
  1. brain
  2. heart
  3. kidneys
  4. blood vessels
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54
Q

What effect does angiotensin II have on the BRAIN which can lead to death ultimately? (2)

A
  • atherosclerosis
  • vasoconstriction
    (therefore stroke or hypertension can lead to death)
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55
Q

What effect does angiotensin II have on the BLOOD VESSELS which can lead to death ultimately? (2)

A
  • vascular hypertrophy
  • endothelial dysfunction
    (therefore stroke, MI, heart failure or hypertension can lead to death)
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56
Q

What effect does angiotensin II have on the HEART which can lead to death ultimately?

A
  • left ventricle hypertrophy
  • fibrosis
  • remodelling
  • apoptosis
    (therefore MI or heat failure can lead to death)
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57
Q

What effect does angiotensin II have on the KIDNEYS which can lead to death ultimately? (4)

A
  • decreased GFR (glomerular filtration rate)
  • increased proteinuria
  • increased aldosterone release
  • glomerular sclerosis
    (therefore renal failure can lead to death)
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58
Q

What are some contraindications (drugs cannot be used and need to be stopped for some situations) when treating hypertension with ACEI? (3)

A
  1. renal failure
  2. hyperkalaemia
  3. renal artery stenosis
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59
Q

What are common adverse drug reactions to antihypertensive drugs? (5)

A
  1. cough
  2. first dose hypotension
  3. taste disturbance
  4. renal impairment
  5. angioneurotic oedema
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60
Q

With which drugs do ACEI drugs interact with? (3)

A
  1. NSAIDs (non-steroidal anti-inflammatory drugs)
  2. potassium supplements
  3. potassium sparing diuretics
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61
Q

What does ACEI and NSAID interaction cause?

A

precipitate acute renal failure

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62
Q

What does ACEI and potassium supplements interaction cause?

A

hyperkalaemia (ACEI cause K conservation)

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63
Q

What does ACEI and potassium sparing diuretics interaction cause?

A

hyperkalaemia (ACEI cause K conservation)

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64
Q

If someone is on ACEI and has low K what does that indicate about their high BP?

A

there is probably a secondary cause for their high BP

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65
Q

Describe the action of ARB drugs. (angiotensin II antagonists/ receptor blockers)

A
  • angiotensin II antagonists competitively block the actions of angiotensin II at the angiotensin AT1 receptor
66
Q

What are 4 types of ARBs (angiotensin II antagonists)?

A
  1. Losartan
  2. Valsartan
  3. Candesartan
  4. Irbesartan
67
Q

What is the main advantage of ARBs over ACEIs?

A

ARBs have NO cough as the adverse drug reaction (not to the same extent) compared to ACEIs

68
Q

What type of drug is atenolol?

A

Beta 1 receptor antagonist (beta blocker) used for CV disease

69
Q

What is better to treat CV disease; atenolol or losartan?

A

Losartan; patients less likely to develop diabetes and reduces risk of developing stroke

70
Q

What are 2 types of calcium channel blockers?

A
  1. vasodilators CCBs

2 rate-limiting CCBs

71
Q

What are 2 types of calcium channel blocker vasodilators?

A
  1. amlodipine

2. felodipine

72
Q

What are 2 types of calcium channel blocker rate limiting drugs?

A
  1. verapamil

2. diltiazem

73
Q

Which group of calcium channel blockers are more commonly used; vasodilators or rate limiting CCBs?

A

vasodilators more commonly used (rate-limitng rarely)

74
Q

How do calcium channel blockers work? (4)

A
  1. block L type Ca channels
  2. selectivity between vascular and cardiac L type channels
  3. relaxing large and small arteries which reduced TPR
  4. reduces cardiac output
75
Q

Vasodilating CCBs are antihypertensive drug treatment in which 2 groups of people?

A
  • people over 55

- women of child bearing age

76
Q

What are the pros for vasodilating calcium channel blockers? (3)

A
  1. compliance is high (people follow medication)
  2. benefit elderly with systolic hypertesnion
  3. rarely cause postural hypertension (sudden high BP when person stands up)
77
Q

Why are women generally more likely to have more side effects from vasodilating calcium channel blockers?

A

women generally have a different vasculature

78
Q

What are common side effects for vasodilating ca channel blockers? (3)

A
  1. facial flushing
  2. peripheral oedema
  3. non-specific headache
    (can be off putting for patients)
79
Q

What are some contraindications (drugs should be stopped or not administered in some situations) for vasodilating ca channel blockers? (3)

A 
If patient has:
- acute MI 
- heart failure 
- bradycardia 
(rate limiting Ca channel blockers)
80
Q

What are adverse drug reactions to vasodilating Ca channel blockers? (6)

A
  1. flushing
  2. headache
  3. ankle oedema
  4. indigestion and reflux oesophagitis
  5. bradycardia
  6. constipation
81
Q

What are 2 types of thiazide type diuretics? (NOT thiazide)

A
  1. indapamide

2. clortalidone

82
Q

Thiazdie type diuretics, are first line treatment for what group?

A

first line treatment in mild-moderate hypertension in Afro-Caribbean populations

83
Q

What can be used anytime in combination with any other antihypertensive drugs?

A

ca channel blockers

84
Q

What is the main benefit of thiazide- type diuretics? (e.g. indapamide and clortalidone)

A

proven benefit in stroke and MI reduction

85
Q

On which section of the nephron do thiazides work on?

A

On distal convoluted tubule

86
Q

Describe the mechanism of action of thiazide-type diuretics. (2)

A
  • Blocks reabsorption of sodium (less Na in blood= lower BP)
  • enhances urinary Na loss
87
Q

How long can the full antihypertensive effect of thiazide-type diuretics take?

A

may take weeks

88
Q

What can adverse drug reactions include in thiazide-type diuretics? (2)

A

-gout
-impotence/ erectile dysfunction
(but generally not common)

89
Q

What are the 3 less commonly used agents if previous treatment options didn’t work?

A
  1. alpha-adrenoceptor antagonists
  2. centrally acting agents
  3. vasodilators
90
Q

What is a common alpha-adrenoceptor antagonist ( less commonly used agent)?

A

Doxazosin

91
Q

What are 2 common centrally acting agents (less commonly used agent)?

A
  1. methyldopa

2. moxonidine

92
Q

What are 2 common vasodilators (less commonly used agents)?

A
  1. hydralazine

2. minoxidil

93
Q

Why should vasodilators be used as a last resort only?

A

They give excessive side effects (e.g. very strong, dry mouth and bad dreams) so can only be used in young people who are intolerable to other medications

94
Q

Describe the mechanism of action for Doxazosin.

A
  • selectively block post synaptic alpa 1 adrenoceptors (alpha 1 blocker means prevents constriction)
  • opposes vascular smooth muscle contraction in arteries
95
Q

What are adverse drug reactions for Doxazosin ( alpha adrenoceptor antagonists) (4)

A
  1. first dose hypotension
  2. dizziness
  3. dry mouth
  4. headache
96
Q

What group of people uses Methyldopa as the main use for treating hypertension?

A

pregnant women (safe to use)

97
Q

Describe the mechanism of action of Methyldopa. (centrally acting agents)

A
  • converted to alpha-methylnoradrenaline which acts on CBS alpha adrenoceptors which decrease central sympathetic flow
98
Q

What are adverse drug reactions to Methyldopa? (5)

A
  1. sedation and drowsiness
  2. dry mouth
  3. nasal congestion
  4. orthostatic hypotension
  5. can cause depression or make post-partum depression worse
99
Q

Describe the mechanism of action of Moxonidine.

A
  • centrally acting Imidazoline agonist (ideal population for using it has not been identified)
100
Q

Describe the hypertension treatment regime for a person who is 55 years + (step by step what is added if oner method has incomplete effect) (5)

A
  1. Start on Ca channel blockers
  2. ADD Thiazide- type diuretic
  3. ADD ACEI (ACE inhibitor)
  4. ADD Beta blockers
  5. ADD one of the less commonly used agents OR send to specialist care
101
Q

Describe the hypertension treatment regime for a person who is less than 55 (step by step what is added if one method has incomplete effect) (5)

A
  1. Start on ACEI (ACE inhibitor); BUT if female of child bearing age then Ca channel blockers or Beta blockers
  2. ADD Thiazide- type diuretic
  3. ADD Ca channel blockers
  4. ADD Beta blocker
  5. Add one of the less commonly used agents OR specialist care
102
Q

What medication is always used instead for pregnant women?

A

Ca channel blockers or Beta blockers (very good for pregnancy)

103
Q

What are the statistics for hypertension and pregnancy?

A

The 2nd most common cause of maternal and foetal death (1st if infection)

104
Q

What is existing primary hypertension (no known cause) a common risk factor for?

A

for preeclampsia (pregnancy disorder characterised by increase in BP and increase in protein in urine)

105
Q

How many women who have primary existing hypertension before pregnancy will develop preeclampsia?

A

~30%

106
Q

What should happen to BP during normal pregnancy?

A

BP should fall however if person has existing hypertension (primary hypertension) then increased risk of pre-eclampsia

107
Q

What is the term that describes rise in BP in pregnancy, which develops into hypertension with NO proteinuria?

A

Gestational hypertension

108
Q

When does gestational hypertension turn into pre-eclampsia? What are the conditions that need to be met before it’s diagnosed as pre-eclampsia?

A
  • Sometimes BP rises severely from about 20 weeks
  • BP> 140/90mmHg
  • proteinuria >300mg/24hours (protein in urine)
109
Q

What are properties of most antihypertensive drugs which is a disadvantage for pregnant women?

A

teratogenic properties

110
Q

What treatment options are available for female patients pre-pregnancy (child-bearing age females) (4)

A
  • Nifedipine modified release
  • Methyl dopa
  • atenolol
  • labetalol
111
Q

What treatment options are available for female patients during pregnancy? (2)

A
  • add thiazide diuretic
    and/or
  • amlodipine
112
Q

What type of nifedipine can only be used in pre-pregnancy women?

A

Only modified release nifedipiene which releases drugs very slowly (whereas immediate release can be fatal in hypertensive patients)

113
Q

When should women preferably be treated for hypertension?

A

preferably before they fall pregnant

114
Q

What is the treatment regime for pre-eclampsia patients? (3)

A
  • added thiazide diuretic and/or amlodipine to nifedipine MR, methyl dopa, atenolol or labetalol)
  • intravenous esmolol added
  • hydralazine added
115
Q

How is hypertension defined in children?

A

defined statistically

116
Q

How is hypertension defined in children in UK?

A

Using UK population data BP >98th centile

117
Q

What BP range indicates high normal BP for age?

A

between 91-98 centile

118
Q

In USA, how is stage 1 hypertension defined in children?

A

BPs from 95th-99th percentile plus 5mmHg

119
Q

In USA, how is stage 2 hypertension defined in children?

A

BP is above 99th percentile plus 5mmHg

120
Q

In USA, how is hypertension defined in children?

A

systolic BP and diastolic BP >=95th percentile for gender, age and height on 3 or more separate occasions

121
Q

What is prevalence for pre- hypertension in children?

A

3-10%

122
Q

What is the prevalence of hypertension depending on age and ethnicity in children?

A

0.1-3%

123
Q

What is the approximate hypertension prevalence in UK?

A

~30% of population

124
Q

What is there evidence of that links childhood hypertension to other conditions? (2)

A

Links it to:

  • adult hypertension
  • target organ damage
125
Q

What is another term for childhood hypertension?

A

childhood hypertension

126
Q

What end-oran effect does childhood hypertension cause? (6)

A
  1. left ventricular hypertrophy (LVH)
  2. decreased vascular responsiveness
  3. increased carotid artery intimal medial thickness (cIMT)
  4. reduced GFR (glomerular filtration rate)
  5. increased atheroma deposition
  6. reduced cognitive scores in hypertensive children
127
Q

What are the commonest causes of hypertension in children; in NEWBORN INFANTS? (4)

A
  • renal artery thrombosis
  • renal artery stenosis
  • congenital renal malformations
  • coarctation (congenital narrowing of short section of aorta)
128
Q

What is the difference between thrombus and embolism?

A
  • Thrombus; abnormal blood clot which adheres to side of blood vessel usually caused by atherosclerosis; often occur in deep veins in legs or cerebral artery
  • Embolus is a floating clot that travels in bloodstream and lodges; usually break off from thrombi
129
Q

What are the most common causes of hypertension in children aged INFANTS-6 YEARS? (3)

A
  1. renal parenchymal disease
  2. coarctation (congenital narrowing of short section the aorta)
  3. renal artery stenosis
130
Q

What are the most common causes of hypertension in children aged 6-10 YEARS? (3)

A
  1. renal parenchymal disease
  2. renal artery stenosis
  3. primary hypertension
131
Q

What are the most common causes of hypertension in children aged 10-18 YEARS? (2)

A
  1. primary hypertension

2. renal parenchymal disease

132
Q

What are the most common causes of childhood hypertension? (2)

A
  1. obesity

2. lack of exercise

133
Q

What is Accelerated Hypertension/ malignant hypertension? (“hypertensive emergency”)

A

Increase in blood pressure to levels >= 180mmHg systolic and >= 110mmHg diastolic resulting in target organ damage
Sudden increase in BP and if untreated can cause serious damage to organs

134
Q

What are common target end organ damage places due to accelerated hypertension? (hypertensive emergency) (4)

A
  • neurological damage
  • cardiovascular damage
  • renal damage
  • grade III retinal changes
135
Q

What is malignant hypertension?

A
  • usually reserved for cases where papilloedema grade 4 fundal changes are present
  • should be treated as a medical emergency
136
Q

Define hypertensive urgency.

A
  • Severe hypertension with NO evidence of target organ damage
  • “urgency” rather than “emergency”
  • recent significant increase over baseline BP that is associated with target organ damage
137
Q

What is accelerated hypertension associated with? (what can lead to it?) (5)

A
  1. an existing diagnosis of hypertension and prescribed antihypertensive agents
  2. poor BP control prior to presentation
  3. lack of primary care contact or healthare in general
  4. non-adherence to medication
  5. illicit drug use both urban and rural communities
138
Q

Why can’t accelerated hypertension studies tell us adequate information? (3)

A
  • studies are retrospective (in past) and small
  • single limited populations
  • generalisability can be an issue
139
Q

Has mortality statistics improved or worsened for accelerated hypertensive patients?

A

Improved generally in UK

140
Q

What is the mean survival time for patients with accelerated hypertension in UK?

A

~18 years

141
Q

According to guidelines, what is the recommendation for how should BP be reduced in hypertensive emergencies (accelerated hypertension)? (3)

A
  • reduce mean arterial pressure by <= 25% for 1st hour
  • by 2-6 hours, reduce to 160/100/110mmHg
  • continue subsequent gradual normalisation over 24-48 hours
142
Q

How should isolated large BP elevations without acute hypertensive urgencies be considered and treated?

A
  • shouldn’t be considered as an emergency but treated by reinstitution or intensification of drug therapy and treatment of anxiety
143
Q

What are isolated large BP elevations without acute hypertensive urgencies associated with? (2)

A

association with:

  • treatment discontinuation or reduction
  • anxiety
144
Q

What NOT to do for hypertensive emergencies? (accelerated hypertension)

A
  1. do not reduce BP suddenly or excessively
  2. do not use sublingual medication
  3. do not use rapidly acting nifedipine or ACEI
  4. do not use intermittent as required therapy; oral or IV
  5. do not use UV hydralazine
  6. do not use sodium nitroprusside
145
Q

Why can’t IV hydralazine be used in hypertensive emergencies? ( accelerated hypertension)

A

5-20 minute lag (falling behind) before producing an erratic response

146
Q

Why can’t sodium nitroprusside be used in hypertensive emergencies? (accelerated hypertension) (3)

A
  1. coronary steal syndrome
  2. increase intracranial pressure
  3. cyanide toxicity
147
Q

What is best treatment for hypertensive emergencies? ( accelerated hypertension)

A

Best managed with CONTINUOUS infusion of a short-acting, titratable antihypertensive agent

148
Q

What will excessive correction of BP in accelerated hypertension patients cause? (if decreased too quickly)

A

It will further reduce organ perfusion and produce multi-organ infarction

149
Q

What administration should be avoided at ALL time for accelerated hypertension emergencies? (2)

A
  1. sublingual administration

2. intramuscular administration

150
Q

What should be set before treating accelerated hypertension?

A

2h and 6h targets that need to be achieved

151
Q

What is the immediate goal when treating accelerated hypertension?

A

to reduce diastolic BP by 15-20% or to about 110mmHg over a period of 30-60 minutes

152
Q

How should agents be administered for treatment of accelerated hypertension? What are the four main steps? (4)

A
  • stabilised with intravenous
    agents
  • oral therapy then initiated
  • intravenous agent is slowly titrated down
  • assess fluid status as patient may be volume deplete (consumed it all)
153
Q

What treatments are used in accelerated hypertension WITH pulmonary oedema? (3)

A
  1. IV GTN started at low dose and up titrate
  2. IV furosemide
  3. initiate oral medication such as amlodipine 5mg and/or other once patient is stable
154
Q

What treatments +doses are used in accelerated hypertension WITH encephalopathy? (4)

A
  1. IV nicardipine, 5mg/h, clevidipine 1-2 mg/h
  2. IV labetalol 0.5-2mg/min
  3. IV esmolol 0.5-1mg/kg loading dose over 1 min, then 50mg/kg/ min up to 300mg/min
  4. initiate oral medication such has amlodipine and/or other once patient stable
155
Q

What are main problems with treatment for accelerated hypertension?

A
  • only 1/3 of patients are appropriately treated in the first 2 hours
  • 60% have excessive BP reduction
  • 11% have treatment failure
  • By 6h, only 13% have been appropriately treated
  • treatment- related adverse events occur in 94% of patients
156
Q

What two drugs may cause profound hypotension with resulting multi-organ infarction when treating accelerated hypertension?

A
  1. sublingual nifedipine

2. intravenous hydralazine

157
Q

What percentage of patients with pre-existing hypertension develop accelerated hypertension?

A

1-2%

158
Q

What do statistics show about accelerated hypertension, in terms of mortality and prevalence.(2)

A
  1. mortality decreased over the last 4 years

2. prevalence and demographics remained unchanged

159
Q

What are patients with accelerated hypertension significantly more at risk for?

A

increased risk of acute and long-term morbidity and mortality

160
Q

What are prognostic indicators of accelerated hypertension? (2)

A
  1. plasma creatinine

2. follow up BP

161
Q

What does current evidence show about therapy for accelerated hypertensive patients?

A

Most patients suffering from it receive less than ideal therapy with high incidence of treatment related adverse effects

162
Q

What are side effects of ACEIs? (CAPTOPRIL)

A
  1. coughing
  2. angioneurotic oedema
  3. protenuria
  4. taste disturbance
  5. other (headache, fatigue, malaise)
  6. potassium increased
  7. renal impairment
  8. itch
  9. low BP (at first dose)

2. Cardiovascular System (42 decks)

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