2- management of hypertension Flashcards
does weight loss help with hypertension?
yes - 1 mmHg for every kg (works for adding kg or losing kg)
does reduced salt help manage hypertension?
yes - no salt added diet reduces blood pressure by 2-4 mmHg
does calcium, magnesium , potassium or combination supplements help management of hypertension?
no = no evidence of blood pressure benefit
does everyone benefit from BP and cholesterol lowering?
yes (to an extent i think?) - high risk normotensives with “normal” cholesterol benefit from BP & cholesterol lowering
what is the steps of drugs you should give for someone less then 55 years old?
Step 1: Offer an ACE inhibitor or ARB.
Step 2: In addition to an ACE inhibitor or ARB, add in a calcium channel blocker or thiazide-like diuretic. Offer a thiazide-like diuretic if there is evidence of heart failure. For full guidance on the management of chronic heart failure, see Chronic heart failure.
Step 3: Offer an ACE inhibitor or ARB, a calcium channel blocker and a thiazide-like diuretic.
what drugs you should give someone who is 55 or older or black patient of any age?
Step 1: Offer a calcium channel blocker.
Step 2: In addition to a calcium channel blocker offer an ACE inhibitor, ARB or a thiazide-like diuretic.
Step 3: Offer an ACE inhibitor or ARB, a calcium channel blocker and a thiazide-like diuretic.
what drugs are preferred with adults who are black-african or african-caribbean family origin?
calcium blocker & diuretic
- prefer ARB over ACEi
what are renin levels like in young & old people?
young people = have high renin and benefit from suppressors
old people = have low renin and benefit from stimulating renin
(renin is in RAAS pathway, more renin →increases blood pressure)
what drug is good for angina & ischaemic heart disease?
beta blockers
what drugs are good for heart failure?
4 pillars = ARNI, beta blockers, mineralocorticoid antagonists, SGLT2 inhibitors
Add ons = Digoxin ( blocks AV conduction) or diuretics (to help oedema, breathlessness)
what drugs are good for diabetic nephropathy?
diabetic nephropathy = complication of diabetes that affect kidneys
- ACE inhibitors & ARBs
what drugs are good for prostatism?
prostatism = symptoms related to enlarged prostate (old term)
alpha blockers
what hypertension drugs are good for the elderly?
thiazides
what are beta blockers good for?
arrhythmias, coronary artery disease, increased sympathetic activity, congestive heart failure
(and young females)
what is first line of drug for hypertension in under 55?
ARBs then ACE inhibitor
is it better to add a drug or increase a dose for hypertension drug treatment?
adding a drug is 5x more effective than titrating (adding dose)
what is a polypill?
multiple drugs in 1 tablet (can be expensive and difficult to sell/make)
what is good about combination therapy?
= more effective than mono-therapy
- also fewer side effects with combination
what makes hypertension resistant hypertension?
- non-concordance (patient not compliant with doctor)
- white coat effect (should check at home as might not be as bad in day to day life)
- lifestyle factors (like cocaine or bad lifestyle)
- drug interactions (NSAIDs like ibuprofen stop diuretics working)
- secondary hypertension (high blood pressure caused by identifiable and often treatable underlying condition)
- true resistance (they actually have resistant hypertension)
when should spironolactone be prescribed?
- it’s the most effective treatment for resistant hypertension
- patients should not be defined as resistant hypertension unless their BP remains uncontrolled by spironolactone
- you have to start low and go slow as it can be safe but only with adequate monitoring
what is renal denervation?
minimally invasive procedure designed to treat resistant hypertension
= The procedure involves using radiofrequency energy or ultrasound to disrupt nerve pathways that contribute to the regulation of blood pressure in the kidneys. The goal is to reduce the activity of these nerves, leading to lower blood pressure
what is carotid baroreceptor stimulation?
= medical intervention in treating hypertension
- small device that sends electrical signals to trick brain that there is high blood pressure therefore wanting to lower BP
