Anti-hypertensives 2 Flashcards
What is ambulatory BP monitoring (ABPM) ?
Device worn during waking hours and BP measure every 30 mins
What is white coat hypertension ?
Having BP recorded can cause it to rise
What is home BP monitoring (HBPM) ?
2 readings, 1 min apart taking in the morning and evening for a week
What is stage 1 hypertension?
BP > or equal to 140/90 and subsequent ABPM/HBPM > or equal to 135/85
What is stage 2 hypertension ?
BP > or equal to 160/100 and subsequent ABPM/HBPM > or equal to 150/95
What is severe hypertension ?
> equal to 180 systolic or > or equal to 110 diastolic
Treatment occurs immediately
What happens if patient has a stage 1 but no end organ damage ?
<40 yes
- check for secondary causes and none then they have to undergo life style changes and if they have secondary causes they are given drugs
40-80yrs
- lifestyle changes
What is defined as end organ damage ?
Heart- hypertropy- checked using an ECG
Kidney - renal function - urine/blood tests
Eye- papillodema, retinal haemorrhage
What happens to a patient with stage 1 and end organ damage ?
Investigate end organ damage to try and treat hypertension
What happens to a patient diagnosed with stage 2 ?
Once confirmed by ABPM then it is treated with drugs
What happens to a patient with stage 3 ?
Treatment is started immediately with no ABPM/HBPM
If there are signs of papillodema or retinal haemorrhage then they are referee to special care on same day
What are the lifestyle changes advised ?
Lose weight Reduce salt intake Stop smoking Reduce alcohol consumption Reduce total fat consumption Increase exercise Increase fruit and veg
What drugs are often administered to young Caucasians ?
ACE inhibitors or at-1 antagonist
What drugs are usually given to Afro-caribeans and patients older than 55?
Thiazides and calcium antagonist
What are the additional pharmacological options for patients with sever hypertension ?
Minoxidil
Hydralazine
Sodium nitroprusside
What drugs can be used in pregnancy for pre-existing hypertension or pre-eclampsia ?
Methyl dopa - reduce sympathetic outflow at medulla
Beta-blockers - only in 3rd trimester
Hydralazine in crisis
How do you measure pulmonary pressure ?
Right side of the heart is catheterised - very invasive so it’s rarely done
What is an indication of pulmonary hypertension ?
Regurgitation from right ventricle to right atrium detected by a stethoscope
Pulmonary emboli is often a common feature so anticoagulants are often taken
What drugs are used to treat pulmonary hypertension ?
Sildenafil - phosphdiesterase inhibitor
Bosentan - et-a antagonist
Epoprostenol- prostacyclin
Illoprost - synthetic prosyacylin analogue
How does sildenafil treat pulmonary hypertension?
Inhibits phosphdiesterase 5 which breaks down cGMP to GTP so it increases cGMP increasing relaxation
How does bosentan treat pulmonary hypertension ?
Blockers et-a and b receptors so it promotes vasodilation
How does prosyacylin and its analogues treat pulmonary hypertension ?
Epoprosterol- prosyacylin - increases cAMP which increases vasodilation - inhibits platelet aggregation - provide symptomatic relief in exercise Illoprost Synthetic
What are the adverse effects of anti-hypertensive ?
Flushing
Headache
Dizziness
What conditions can each of these drugs not be used in ?
- captopril
- candesartan
- bendrofluemethiazide
- propranolol
- bosentan
Captopril - pregnancy Candesartan - pregnancy or breast feeding Bendrofluemethiazide - hyponatraemia Propranolol- agh,as Bosentan- pregnancy and breat St feeding
