Blood pressure conditions

Question 1

what is step 1 for the use of antihypertensives?

Answer 1

-patient <55 years old and not of African/carribean origin OR has type 2 diabetes then give ACEi/ARB

-if patient is 55 years or older OR of African/carribean origin give a CCB

Question 2

WHAT IS STEP 2 FOR THE USE OF ANTIHYPERTENSIVES?

Answer 2

-patient <55 years old and not of African/carribean origin OR has type 2 diabetes then give ACEi/ARB + CCB OR thiazide like diuretic

-if patient is 55 years or older OR of African/carribean origin give a CCB + ACEi/ARB OR thiazide like diuretic

Question 3

what is step 3 for the use of antihypertensives?

Answer 3

can give to anyone ACEi or ARB+ CCB + thiazide-like diuretic

Question 4

what is step 4 for the use of antihypertensives?

Answer 4

Confirm resistant hypertension: confirm elevated BP with ABPM or HBPM, check for postural hypotension and discuss adherence
Consider seeking expert advice or adding a:
* low-dose spironolactone if blood potassium level is ≤4.5 mmol/l
* alpha-blocker or beta-blocker if blood potassium level is >4.5 mmol/l
Seek expert advice if BP is uncontrolled on optimal tolerated doses of 4 drugs

Question 5

what is classed as a normal blood pressure?

Answer 5

120/80mmHG

Question 6

what is considered as stage 1 hypertension and what is the treatment and when?

Answer 6

140/90- where lifestyle advice is given
-only treat if under 80 with:
-target organ damage
-established cardiovascular disease
-renal disease
-diabetes
-an estimated 10‑year risk of cardiovascular disease of 10% or more.

Question 7

what is considered as stage 2 hypertension and when do you treat?

Answer 7

160/100 or over but less than 180/120 mmHg and subsequent ABPM daytime average or HBPM average blood pressure of 150/95 mmHg or higher.
-treat everyone

Question 8

what is considered as stage 3 hypertension and when do you treat?

Answer 8

-over 180 systolic or clinic diastolic blood pressure of 120 mmHg or higher
-hypertensive emergency= acute target organ damage, intravenous, reduce BP slowly otherwise reduced organ perfusion= blindness, MI, cerebral infarction and severe renal impairment
-hypertensive urgency= without target organ damage, oral reduce BP slowly over 24-48hrs

Question 9

what is the target BP for patients under 80 years old?

Answer 9

-<140/90
-130/80 in atherosclerotic CVD OR diabetes with kidney, eye, or cerebrovascular disease.

Question 10

what is the target BP for patients over 80 years old?

Answer 10

<150/90

Question 11

what is the target BP for patients with renal disease?

Answer 11

<140/90
<130/80 if CKD, diabetes, proteinuria >1g in 24hrs
consider ACEi/ARB if proteinuria present

Question 12

what is the target BP for patients with diabetes?

Answer 12

<140/80
<130/80 if complications eye, kidney or cerebrovascular disease

Question 13

what is the target BP for patients who are pregnant?

Answer 13

-<150/100 chronic hypertension
-<140/90 chronic hypertension and if target organ

Question 14

what are some examples of ACEi? what is the dose

Answer 14

-captopril (BD) first dose ON
-Fosinipril
-lisinopril
-ramipril
-perindopril (30-60mins before food)
-quinapril

Question 15

what are some examples of ARBs?

Answer 15

-candersartan
-valsartan
-losartan
-olmesartan

Question 16

what are some side effects of ACEis?

Answer 16

-persistent dry cough (can give ARB as an alternative)
-hyperkalaemia (higher risk in renal impairment and diabetes)
-Anaphylactoid reactions e.g. angioedema
-oral ulcers
-taste disturbance
-hypoglycaemia

Question 17

WHAT ARE SOME OF THE RENAL EFFECTS OF ACEI’S?

Answer 17

-RENAL EFFECTS
-renoprotective in renal disease e.g. CKD
-nephrotoxic= acute kidney injury; avoid DAMN (diuretics, ACE,ARBs, metformin, NSAIDs)
-reduce eGFR via efferent dilation. Avoid in renovascular disease. (may give in unilateral renal artery stenosis not severe bilateral stenosis.

Question 18

what are the hepatic effects of ACEi’s?

Answer 18

-cholestatic jaundice, hepatic failure-stop if liver transaminases 3X normal or jaundice occurs.

Question 19

are ACEi ALRIGHT TO BE USED IN PREGNANCY?

Answer 19

TO BE AVOIDED.

Question 20

what are some drug interactions with ACEi?

Answer 20

-hyperkalaemia= aliskeren, ARB, K+ sparing diuretics/aldosterone antagonist
-nephrotoxicity and reduced eGFR= NSAID
-hypotension=diuretics
-renal impairment, hyperkalaemia and hypotension=renin-angiotensin system drugs i.e. ACE/ARBS, renin inhibitors. AVOID concomitant ACE+ARB in diabetic nephropathy

Question 21

what are angiotensin-II receptor blocker? and their SE

Answer 21

centrally acting anti-hypertensives
-methyldopa- SE= driving drowsiness
-clonidine- SE= flushing
-Moxonidine

Question 22

WHAT ARE SOME VASODILATORS ANTIHYPERTENSIVES?

Answer 22

-hydralazine- SE= fluid retention, tachycardia
-minoxidil-SE=tachycardia, fluid retention and increase cardiac output.

Question 23

what are some examples of alpha-blockers?

Answer 23

-prazosin
-terazosin
-indoramin

Question 24

what are some examples of beta-adrenoreceptor blocker?

Answer 24

-atenolol
-bisoprolol
-labetalol (in pregnancy)
-metroprolol

Question 25

what are the different classes of beta-blockers? pnemonic

Answer 25

-ice PACO -water CANS -Be A MAN -BACoN

Question 26

what beta-blockers are under ice PACO and the effect of them?

Answer 26

-intrinsic sympathomimetic activity -less bradycardia -less coldness of extremities Pindolol Acebutol Celiprolol Oxprenolol

Question 27

what beta-blockers are under water CANS and the effect of them?

Answer 27

-water-soluble; less likely to cross blood-brain-barrier -less nightmares and sleep disturbances -reduce dose in renal impairment as renally cleared Celiprolol Atenolol Nadolol Sotalol

Question 28

what beta-blockers are under Be A MAN and the effect of them?

Answer 28

cardio-selective=less bronchospasm -well controlled asthma under a specialist if no other choice Bisoprolol Atenolol Metoprolol Acebutol Nebivolol

Question 29

what beta-blockers are under BACoN and the effect of them?

Answer 29

-Once daily dosing -intrinsically long duration of action Bisoprolol Atenolol Celiprolol Nadolol

Question 30

what are some side effects of beta-blockers?

Answer 30

-bradycardia, hypotension -hyperglycaemia OR hypoglycaemia (masks symptoms of hyperaemia e.g. tachycardia)

Question 31

what are some contra-indications of beta-blockers?

Answer 31

-asthma: causes bronchospasm (this includes B-blocker eye drops e.g. timolol -worsening unstable heart failure -second/third degree heart block -severe hypotension and bradycardia

Question 32

what are some interactions of beta-blockers?

Answer 32

-asystole and hypotension -hyperglycaemia; avoid in diabetes/high risk of diabetes (thiazide-like-duirectis

Question 33

what are some examples of dihydropyridine CCB: vasodilations?

Answer 33

-amlodipine -felodipine -lacidipine -lercanidipine -nifedipine (maintain the same modifies-release brand)

Question 34

what are some side effects of CCB?

Answer 34

ankle swelling, flushing, headaches (common)

Question 35

what are some rate-limiting CCB? what are some SE and when should it be avoided?

Answer 35

-avoided in heart failure -verapamil (causes constipation, only CCB licensed for arrhythmias) -diltiazem (maintain on same brand when doses >60mg)

Question 36

what are some interactions of CCB?

Answer 36

-increased CCB concentration: avoid grapefruit (enzyme inhibitor.

Question 37

what are phaechromocytoma?

Answer 37

bet-blockers +alpha-blockers (phenoxybenzamine

Question 38

what are some examples of vasoconstrictors and what do they do?

Answer 38

-raise blood pressure transiently by acting on alpha-adrenergic receptors to constrict peripheral blood vessels -noradrenaline -phenylephrine (long acting: prolonged rise in blood pressure)

Question 39

what are some SE of vasoconstrictor?

Answer 39

-reduced perfusion to vital organs e.g. kidneys