Cardiovascular drugs 2 Flashcards
How many adults does hypertension affect in the UK?
1 in 4
What is hypertension a major risk factor for?
MI Stroke Chronic kidney disease Heart failure Dementia
What happens for every 10mmHg reduction in systolic blood pressure?
17% reduction of CHD
27% reduction of stroke
28% reduction of heart failure
13% reduction in all causes of mortality
What is hypertension?
Clinic BP >140/90
How is hypertension diagnosed?
Take a second or third measurement
Offer ambulatory blood pressure monitoring
If patient unable to tolerate ambulatory blood pressure monitoring - offer home blood pressure monitoring
What will affect the BP reading?
Cuff too small - 10 to 40 increase Cuff over clothing - 10 to 40 increase or decrease Back/feet unsupported - 5 to 15 increase Legs crossed - 5 to 8 increase Not resting (3-5mins) 10-20 increase Patient talking 10 to 15 increase Pain 10 to 30 increase
Describe home blood pressure monitoring
2 consecutive seated measurements, at least 1 minute apart
Blood pressure is recorded twice a day for at least 4 days - 1 week
Measurements on 1st day are discarded
What blood pressures consist of hypertension diagnosis
Clinic BP >140/90
ABPM/HBPM> 135/85
What are the outcomes of monitoring blood pressure for diagnosis?
Normotensive by both methods - true normontension
Hypertensive by both methods - true hypertension
Hypertensive based on office BP and normotensive by ABM/HBPM - White coat hypertension
Normotensive by clinic BP and hypertensive by ABP/HBPM - Masked hypertension
What are the causes of hypertension?
Primary - Essential >90%
Secondary <10%
- renal disease - renovascular disease, renal parenchymal disease
- Endocrine disease - conns, cushings, phaeochromocytoma
- Drugs - COC pills, steroids, NSAIDs, Cocaine, EPO
- Vascular
- Others - obstructive sleep apnoea. pregnancy
List some contributing factors to hypertension
High BMI > 14 units of alcohol a week salt intake lack of exercise stress caffeine
List the risk factors for hypertension
Male Age Family history Ethnicity Smoker Cholesterol Diabetes
Describe the pathophysiology of hypertension
BP = CO X SVR
CO = HR X SVR
Describe the symptoms of hypertension
Asymptomatic Headache Blurred vision Dizziness Shortness of breath Palpitations Epistaxis
What examinations are necessary in terms of hypertension
Cardiovascular system
Abdomen
Fundoscopy
What investigations are necessary in terms of hypertension
Urinalysis - Proteinuria, haematuria
ECG - LVH, AF
Blood tests - U&Es, LFTs, lipids, glucose/HBA1C
Describe the non drug treatment of hypertension
Weight reduction DASH diet Dietary sodium restriction Physical activity Alcohol moderation
What is the drug choice for hypertension
ACEi/ARBs - hypertension with type 2 diabetes or age <55 and not of afrocarribean origin.
CCB - Hypertension without type 2 diabetes, age >55, black african or afrocarribean origin
If these do not work - add CCB, ACEi/ARBs or thiazide like diuretics
Resistant hypertension is when none of these drugs work and low dose spironolactone or alpha or beta blocker used
What must be monitored when using ACEi/ARBs
Check Serum creatinine and potassium - before staring therapy 1-2 weeks
If serum creatinine increases by >50% or GFR falls >25% or K>6 - stop drug, repeat tests and consider other causes
