2. Hypertension Flashcards by Nunu khan

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

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When to take the first ever dose of hypertension

At night

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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

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Hypertension

Step 2 (age dependent)

Add to step 1

STEP 2
<55

CCB (if CI or HF)
Give TLD

ADD
>55
ACE /ARB

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Hypertension

Step 3

Not age or origin dependent

ACE/ ARB

CCB

TLD

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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

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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

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CCB in hypertension

Calcium channel blockers

List (3)

Amlodipine
Felodipine
Nifedipine

———

Verapamil
Dilitiazem
(Avoid in HF)

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CCB

Side effects

Constipation.
Dizziness.
Fast heartbeat (palpitations)
Fatigue.
Flushing.
Headache.
Nausea.
Rash
Swollen legs

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CCB

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

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Verapamil
Diltiazem

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

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Hypertension

If CCB contra indicated
What to give —->

If ACE/ARB contra indicated
Wgat to give?——>

TLD

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THIAZIDE LIKE DIURETIC

In hypertension

TLD

List

Indapramide
Cortalidone
Metolazone

Avoid in afro and diabetes

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TLD

Alkalosis hypochloraemic; 
constipation; diarrhoea; 
dizziness; 
dry mouth; 
electrolyte imbalance; 
erectile dysfunction; 
fatigue; headache; 
hyperglycaemia; 
hyperuricaemia; 
nausea; 
postural hypotension; 
skin reactions

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TLD

Addison’s disease; 
hypercalcaemia; 
hyponatraemia; 
refractory hypokalaemia; 
symptomatic hyperuricaemia

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ARB

Angiotensin II receptor blocker

List

Valsartan
Losartan
Candesartan
Irbesartan

(Preferred in Afro pts)

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ARB

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

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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

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ACEi

ACE inhibitors

List

Benazepril 
Captopril.
Enalapril 
Fosinopril.
Lisinopril 
Moexipril.
Perindopril.
Quinapril

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ACE

when to take

How often?

To be taken 30-60mints BEFORE A MEAL

Usually it’s OD
Unless captopril BD

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ACEi

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