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Medicine > Case 8 - Hypertension - Progress Test > Flashcards

Case 8 - Hypertension - Progress Test Flashcards

1
Q

What is the pharmacology of ACE-i?

A

Inhibit the conversion of angiotensin I to angiotensin II

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2
Q

What are common side effects of ACE-i?

A

Cough
Angioedema
Hyperkalaemia

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3
Q

What patients should ACE-i be avoided in?

A

Pregnant women

Less effective in Afro-Caribbean patients

May worse renal function in patients with renovascular disease

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4
Q

What is the pharmacology of calcium channel blockers?

A

Block voltage-gated calcium channels, relaxing vascular smooth muscle and force of myocardial contraction

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5
Q

What are common side effects of calcium channel blockers?

A

Flushing
Ankle swelling
Headache

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6
Q

What is the pharmacology of thiazide-like diuretics?

A

Inhibit sodium absorption at the beginning of the distal convoluted tubule

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7
Q

What are common side effects of thiazide-like diuretics?

A

Hyponatraemia
Hypokalaemia
Dehydration

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8
Q

What is the pharmacology of ARBs?

A

Block the effects of angiotensin II and the AT1 receptor

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9
Q

What are common side effects of ARBs?

A

Hyperkalaemia

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10
Q

What is the suffix used for ARBs?

A
  • sartan
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11
Q

What are ARBs used?

A

Generally when ACE-i haven’t been tolerated well or in Afro-Caribbean patients

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12
Q

What is the first line hypertension medication for people under 55 years old?

A

ACE-i

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13
Q

What is the first line antihypertensive medication for people with type 2 DM?

A

ACE-i

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14
Q

What is the first line anti-hypertensive for patients over 55 years old?

A

Calcium channel blocker

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15
Q

What is the first line anti-hypertensive for patients of Afro-Caribbean origin?

A

Calcium channel blocker

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16
Q

What is the second line anti-hypertensive?

A

ACE-i (/ARB) + Calcium channel blocker

or ACE-i + thiazide-like diuretic

17
Q

What is 3rd line anti-hypertensive?

A

ACE-i + CCB + thiazide-like diuretic

18
Q

What is 4th line anti-hypertensive?

A

If K <= 4.5 –> low-dose spironolactone

If K > 4.5 –> beta blocker / alpha blocker

19
Q

What is 5th line antihypertensive?

A

Refer for specialist review

20
Q

What are some secondary renal causes of hypertension?

A
  • GN
  • Chronic pyelonephritis
  • Adult polycystic kidney disease
  • Renal artery stenosis
21
Q

What are some seconadry endocrine causes of hypertension?

A
  • Primary hyperaldosteronism
  • Phaeochromocytoma
  • Cushing’s syndrome
  • Liddle-s syndrome
  • Congenital adrenal hyperplasia
  • Acromegaly
22
Q

What are some other seconadary causes of hypertension?

A
  • Glucocorticoids
  • NSAIDs
  • Pregnancy
  • Coarctation of the aorta
  • Combined oral contraceptive pill
23
Q

How many stages of hypertension are there?

A

3

24
Q

What BP is stage 1 hypertension?

A

Clinic BP >= 140/90 and ABPM >= 135/85

25
Q

What BP is stage 2 hypertension?

A

Clinic BP >= 160/100 and ABPM >= 150/95

26
Q

What BP is severe hypertension (Stage 3)?

A

Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHG

27
Q

What management should be done if clinic BP is >= 180/120

A

Admit for specialist assessment if:

  • signs of retinal haemorrhage or papilloedema (accelerated hypertension)
  • life-threatening signs eg. new-onset confusion, chest pain, signs of HF, AKI

Refer for specialist assessment if phaechromocytoma is suspected

If not admitting, arrange urgent investigation for end-organ damage

If end organ damage is found:
- Start anti-hypertensive immediately

If no target organ damage is identified:
- repeat clinic BP within 7 days

28
Q

When should you treat a patient with stage 1 hypertension on ABPM (>= 135/85)?

A

If < 80 AND:

  • target organ damage or
  • established cardiovascular disease or
  • renal disease or
  • diabetes or
  • 10-year cardiovascular risk equivalent is 10% or greater
29
Q

When should you start anti-hypertensives in patients with stage 2 hypertension on ABPM (>=150/95) ?

A

Offer drug treatment to all patients with stage 2 hypertension

30
Q

What is the target BP for patients over 80?

A

Clinic BP <= 150/90

ABPM <= 145/85

31
Q

What is involved in the RAAS system?

A

A fall in BP or fluid volume triggers renin release from the kidney

Renin converts angiotensinogen (produced by the liver) to angiotensin I

Angiotensin-converting enzyme (released from the lungs) converts angiotensin I to angiotensin II

Angiotensin II acts directly on the blood vessels triggering vascoconstriction

Angiotensin II also acts on the adrenal gland to stimulate the release of aldosterone

Aldosterone acts of the kidneys to stimulate reabsoption of NaCl and H2O

Medicine (15 decks)

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