Blood pressure conditions Flashcards
Hypertension treatment step 1
AB<55: ACE or ARB (B blocker if ACE/ARB not tolerated/CI)
CD 55+* : CCB (if high risk of HF/CCB not tolerated?CI, use TLD)
*includes Africans/Caribbeans
Hypertension treatment step 2
AB<55: CCB (if high risk of HF/CCB not tolerated?CI, use TLD)
CD 55+* : ACE or ARB (ARB preferred in African/Caribbean people)
Hypertension treatment step 3
All: ACE/ARB + CCB + TLD
Hypertension treatment step 4 (resistant HTN)
Add diuretics such as low dose spiro, or high dose TLD (if K+>4.5). If other diuretics ineffective/CI, add B blocker
Hypertension stage 1
140/90 - lifestyle advice only. Only treat if under 80 and target organ damage (retinopathy, LVH, CKD), CVD or 10 year risk of CVD >20%, renal disease or diabetes.
Hypertension stage 2
160/100 - treat all
Hypertension stage 3
> 180/>110 Hypertensive crises
Hypertensive emergency: acute target organ damage- use IV treatment, slowly reduce or reduced perfusion -> blindness, MI, infarcts, AKI.
Hypertensive urgency, no damage, oral, reduce slowly over 24-48h.
BP Target: <80
<140/90
<130/80 in artherosclerotic CVD, DM with kidney, eye or cerebrovasc disease
BP Target: >80
<150/90
BP Target: renal disease
<140/90
<130/80 in CKD, DM, proteinuria (ACE/ARB preferred in proteinuria)
BP Target: Diabetes
<140/80
<130/80 if complications (eye, kidney, cerebrovasc)
BP Target: pregnancy
<150/100 chronic HTN
<140/90 chronic HTN + target organ damage, given birth
Labetolol (nephrotoxic) 1st choice, widely used in gestational HTN.
ACEi ADRs
Persistent dry cough (caused by bradykinin breakdown inhibition, try ARB as alternative), hyperkalemia (high risk in renal imp & DM. anaphylactoid reactions (eg angiodema)
ACEi renal effects
Renoprotective in CKD, nephrotoxic in AKI.
Reduces eGFR via efferent arteriole dilation. avoid in renovascular disease (may give if unilateral, NOT in bilateral stenosis)
ACEi hepatic effects
can cause cholestatic jaundice, hepatic failure, stop if liver transaminases 3x normal or if jaundice occurs.
ACEi ADRs
Renal and hepatic ADRs, mouth ulcers, taste disturbance, hypoglycaemia. Avoid in pregnancy
ACEi interactions
^K+ - aliskeren, ARB, K sparing diuretics/aldosterone antagonists.
Nephrotoxicity (NSAIDs)
Hypotension (diuretics)
ARB MOA:
block angiotensin II receptor, doesn’t inhibit breakdown of bradykinin (hence no dry cough like ACEi)
Alpha blocker MOA:
reduces smooth muscle contraction in blood vessels reducing BP
B blocker (ice PACO)
Propranolol, Acebutol, Celiprolol and Oxprenolol
intrinsic sympathomimetic activity - less bradycardia and coldness of extremities
B blocker (watering CANS)
Celiprolol, Atenolol, Nadolol, Sotalol
water soluble, don’t cross BBB, less nightmares (reduce dose in renal impairment as renally excreted)
B blocker (ABMAN)
Acebutol, Bisoprolol, Metoprolol, Atenolol, Nebivolol
Cardioselective - less bronchospasm - used in well controlled asthma
B Blocker (BACoN)
Bisoprolol, Atenolol, Celiprolol, Nadolol
Long acting, OD dosing.
B Blocker ADRs
Bradycardia, hypotension, hyper/hypoglycemia (masks symptoms of hypos eg tachycardia)
B Blocker CIs
Asthma (including timolol drops), worsening/unstable HF, second/third degree heart block, severe hypotension and bradycardia
B blocker interactions
Asystole and hypotension - rate lim CCBs (particularly verapamil inj)
Hyperglycemia- avoid in DM - (TLDs eg bendroflum)
CCB MOA
blocks Ca channels, reducing contraction force, conductivity and vascular tone.
Dihydropyridines ADRs
Ankle swelling, flushing, headaches
Rate lim CCBs info
Verapamil (causes constipation, only CCB licensed in arrhythmias), Diltiazem (brand specific if >60mg)
CCB interactions
enzyme inhibitors increase CCB concentrations
Hypotension and shock treatment
Vasoconstrictor sympathomimetics eg (Nor)adrenaline
Vasoconstrictor sympathomimetics MOA
raise BP transiently by acting on alpha receptors causing vasoconstriction
Vasoconstrictor sympathomimetics ADRs
reduced perfusion to vital organs (eg kidneys)
