2. Hypertension Flashcards
HYPERTENSION
What is it and what are the symptoms
High blood pressure, is when the pressure in your blood vessels is unusually high. It can be serious if not treated
High blood pressure does not usually have any symptoms. The only way to find out if you have it is to get your blood pressure checked
When to take the first ever dose of hypertension
At night
Hypertension
Step 1 (age dependent)
Pt <55
⭕️ACE
(if cough or Afro pt)
Give:
ARB
If both CI give BB
⭕️If pts >55 or (African)
CCB
If CI or HF
Give TLD
Hypertension
Step 2 (age dependent)
Add to step 1
STEP 2
<55
CCB (if CI or HF)
Give TLD
ADD
>55
ACE /ARB
Hypertension
Step 3
Not age or origin dependent
ACE/ ARB
+
CCB
+
TLD
Hypertension
Step 4
(Specialist)
Resistant hypertension
ADD to step 3
low-dose spironolactone
if blood potassium level is ≤4.5 mmol/l
blood potassium >4.5 mmol/l
Give high dose TLD
If CI
Give
AB or Bb
Spironolactone
Class
Side effect
aldosterone receptor antagonist
It causes the kidneys to eliminate unneeded water and sodium from the body into the urine but reduces the loss of potassium from the body.
Hyperkalamia Drowsiness dizziness lightheadedness stomach upset diarrhea nausea vomiting headache
CCB in hypertension
Calcium channel blockers
List (3)
Amlodipine
Felodipine
Nifedipine
———
Verapamil
Dilitiazem
(Avoid in HF)
CCB
Side effects
Constipation. Dizziness. Fast heartbeat (palpitations) Fatigue. Flushing. Headache. Nausea. Rash Swollen legs
CCB
CI
HF, grapefruit juice
Cardiac outflow obstruction; significant cardiac valvular obstruction (e.g. aortic stenosis); uncontrolled heart failure unstable angina; within 1 month of myocardial infarction
Verapamil
Diltiazem
CI
HF
Acute porphyrias;
atrial flutter or fibrillation associated with accessory conducting pathways (e.g. Wolff-Parkinson-White-syndrome);
bradycardia;
cardiogenic shock;
heart failure (with reduced ejection fraction);
history of significantly impaired left ventricular function (even if controlled by therapy);
hypotension;
second- and third-degree AV block;
sick sinus syndrome;
sino-atrial block
Hypertension
If CCB contra indicated
What to give —->
If ACE/ARB contra indicated
Wgat to give?——>
TLD
BB
THIAZIDE LIKE DIURETIC
In hypertension
TLD
List
Indapramide
Cortalidone
Metolazone
Avoid in afro and diabetes
TLD
SE
Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; dry mouth; electrolyte imbalance; erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions
TLD
CI
Addison’s disease; hypercalcaemia; hyponatraemia; refractory hypokalaemia; symptomatic hyperuricaemia
ARB
Angiotensin II receptor blocker
List
Valsartan
Losartan
Candesartan
Irbesartan
(Preferred in Afro pts)
ARB
SE
Abdominal pain;
asthenia; abnormal physical weakness or lack of energy.
back pain; cough; diarrhoea; dizziness; headache; hyperkalaemia; hypotension; nausea; postural hypotension (more common in patients with intravascular volume depletion, e.g. those taking high-dose diuretics); renal impairment; vertigo; vomiting
Postural hypotension
What is it
Common in pts taking TLD
Postural hypotension
(also called orthostatic hypotension) is a condition in which a person’s blood pressure drops abnormally when they stand up after sitting or lying down
ACEi
ACE inhibitors
List
Benazepril Captopril. Enalapril Fosinopril. Lisinopril Moexipril. Perindopril. Quinapril
ACE
when to take
How often?
To be taken 30-60mints BEFORE A MEAL
Usually it’s OD
Unless captopril BD
ACEi
SE
Dry cough.
Increased potassium levels in the blood (hyperkalemia)
Fatigue.
Dizziness from blood pressure going too low.
Headaches.
Loss of taste.
Avoid in RENAL IMPAIRMENT
ACEi
Contra indication
idiopathic angioedema
Renal impairment
the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
eGFR less than 60 mL/minute/1.73 m2;
People with diabetes and kidney disease are at increased risk of hyperkalemia so ACE inhibitors must be used with caution in these patients. Symptoms of hyperkalemia include: general weakness, confusion, and muscle cramps. In severe cases, hyperkalemia can lead to dangerous cardiac arrhythmias (an abnormal heartbeat).
Hypertension
Stage 1
Always -5 if done at home/ambulatory
140/90
- Life style advice
- If age over 80 + 1 or more of the list: GIVE MEDS
CVD
Diabetes
Renal disease
10 yr CVD risk greater than 20%
Hypertension
Stage 2
160/100 +
Treat regardless of age
Stage 3
Severe hypertension
(Crisis)
Hospital referral!!! Stat
180/110 +
Hypertensive emergency:
Risk of acute target organ damage
Give: IV HYDRALAZINE
Hypertensive urgency:
No acute target organ damage: give oral
Anti hypertensive
(Increase slowly over 24-48hrs)
Why does hypertensive lowering have to be slow?
To Avoid organ damage due to reduced perfusion.
If done fast can cause:
MI
BLINDNESS
RENAL DETERMINATION
CEREBRAL INFRACTION
What’s is the normal range for
BP
Where is the systolic number?
120/80
Above number is systolic
When is an ALPHA-blocker + BETA-blocker given at the same time?
The only indication
A pheochromocytoma
is a tumor in the adrenal gland. It causes the gland to make too much of the hormones epinephrine and norepinephrine. This tumor often occurs when you are in your 30s, 40s, or 50s. It happens to both men and women.
CCB
Contra indicated which ♥️ conditions
(4)
Angina
Arrhythmia
HF
within 1 month of MI
What do
Alpha blockers do
Reduce BP
And prostate problems
Beta blockers
what do they do
Reduce HF
Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure
Verapamil & diltiazem
SE
Constipation
+ all other SE of all CCB
Clinic BP target
1) Under 80
2) + Arthosclerotic CVD Diabetes Kidney Eye Cerebrovascular disease
1) 140/90 or less
2) 130/80 or less
Clinic BP target
Over 80
150/90 or less
Clinic BP target
1) renal disease
2) +
CKD
Diabetes
Proteinuria more than 1g/24hrs
1) 140/90 or less
2) 130/90 or less
Clinic BP target
1) diabetes
2) +
Eye
Kidney
Cerebrovascular disease
1) 140/90 or less
2) 130/80 or less⚠️
Clinic BP target
1) Pregnancy chronic hypertension
2) +
or just given birth
Target organ damage
Treat with:
1) 150/100 or less
2) 140/90 or less
Labetalol (hepatoxic) 1st choice in ⬆️BP in pregnancy
OR
Methldopa (stop 2 days after birth)
OR
MR nifedipine (= unlicensed)
Which drugs to give In Pregnancy For hypertension (3)
Labetalol (hepatoxic) 1st choice in ⬆️BP in pregnancy
OR
Methldopa (stop 2 days after birth)
OR
MR nifedipine (= unlicensed)
Which drugs to TEMPORARILY stop in renal impairment
DAMN
DIURETIC
ACE/ARB
METFORMIN
NSAIDs
When to stop ACE in liver problems
transaminases X3 normal
Jaundice occurs , oral ulcers, taste disturbance, hypoglycaemia
ACE in pregnancy?
Avoid! Unless absolutely essential
ACE
and hypoglycaemia and hyperkalaemia
Hyperkalaemia is linked to hypoglycaemia and vice versa
Keep Same brand
MR Nitidipine
Diltiazem doses 60mg and over
Drugs causing hyperkalaemia
ARB ACE Potassium sparing diuretics Spironolactone Aliskeren NSAIDs
Vasodilators
used in hypertension
SE
Hydralazine
SE Fluid-retention
Minoxidil
SE tachycardia, fluid retention, increase cardiac output
Alpha-blockers
in hypertension
Alfuzosin
Doxazosin
Prazosin
Tamsulosin
Silodosin
Terazosin
Alpha-blockers
SE
Asthenia; constipation; depression; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; headache; nasal congestion; nausea; nervousness; oedema; palpitations; postural hypotension; sexual dysfunction; skin reactions; syncope; urinary disorders; vertigo; vision blurred; vomiting
Centrally acting hypersensitives
3
Methyldopa- driving caution
Clonidine - flushing
Moxomidine
Not used much due to SE
dry mouth, dizzy, impotence
Beta blockers
List
atenolol bisoprolol carvedilol. esmolol. metoprolol nebivolol (70+ in hypertension) propranolol
Increase blood pressure and DIABETES TYPE1
indicates what?
Diabetic nephropathy
Treating hypertension in diabetes type 2
Prevents what ?
Micro albuminuria
Which can progress to diabetic nephropathy
