Cardiovascular Drugs 2 Flashcards
when is BP defined as HTN?
Clinic BP ≥140/90
what can affect BP reading?
Cuff too small Cuff over clothing Back/feet unsupported Legs crossed Not resting (3 – 5 minutes) Patient talking Pain
what are the clinic BP outcomes?
Normotensive by both methods (true normotension)
Hypertensive by both methods (true hypertension)
Hypertensive based on office BP and normotensive by ABP/HBPM (white-coat hypertension)
Normotensive by clinic BP and hypertensive by ABP/HBPM (masked hypertension)
what are the causes of HTN?
Primary (Essential) >90%
Secondary <10%
- Renal disease – renovascular disease, renal parenchymal disease - Endocrine disease – Conn’s, Cushing’s, Phaeochromocytoma - Drugs – COC Pills, Steroids, NSAIDS, Cocaine, EPO - Vascular - Others – Obstructive Sleep Apnoea, Pregnancy Induced
Risk factors HTN
Male
Age
Family history + Ethnicity
Smoker
Cholesterol
Diabetes
Symptoms of HTN
None – ‘Silent Killer’
Headache
Blurred vision
Dizziness
Shortness of breath
Palpitations
Epistaxis
what non-drug treatment in HTN?
- weight reduction
- DASH
- Dietary sodium restriction
- Physical activity
- Alcohol moderation
are ACEi and ARBS allowed in pregnancy?
Contraindicated in pregnancy
Contraindicated in breast feeding
Alternatives – labetalol, methyldopa, nifedipine/amlodipine
Check if in doubt!
what are the targets in proteinuria?
Proteinuria low: ACR<70 or PCR<100 - Target blood pressure <140/90
Proteinuria high: ACR>70 or PCR>100 - Target blood pressure <130/80
ACE inhibitors or ARBs should be included in:
Patients with urinary ACR>30 or PCR>50
Diabetic patients with microalbuminuria
what are the targets used in older patients?
Check for postural hypotension
Treat to below NICE targets in >80 year old patients ie CBP<150/90 or ABPM/HBPM <145/85
Use clinical judgement
define hypertensive crises
Severe “hypertension” (BP≥ 180/120 mmHg) with acute damage to the target organs
Lower BP in minutes to hours!!
Hypertensive urgency
Severe “hypertension” without acute damage to the target organs
Lower BP after a review within 7 days
what are the sx of a hypertensive crises?
Asymptomatic Headache Epistaxis Presyncope Palpitations
Chest pain
Dyspnoea
Neurological deficit
what are the organs affected in HTN crises?
Eyes (papilloedema)
Brain (encephalopathy, stroke)
Heart (pulmonary oedema, MI)
Kidneys (AKI)
Aortic dissection
how do you treat HTN crises?
Hypertensive emergency Same day specialist review IV Therapy – Labetalol, GTN, Sodium nitroprusside, Esmolol Reduce BP/MAP (20–25% in the 1-2 hours) Target of 160/100 in 6 hours
Hypertensive urgency
ABPM/HBPM
GP follow up within 7 days
Oral treatment
when should statins be offered in CKD patients?
CKD 3
