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BNF > CHAPTER 2: CVS: Hypertension > Flashcards

CHAPTER 2: CVS: Hypertension Flashcards

1
Q

What does lowering blood pressure reduce the risk of? (4)

A
  1. Stroke
  2. Coronary heart events
  3. Renal impairment
  4. Heart failure
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2
Q

What lifestyle advice should patients with hypertension be given? (7)

A
  1. Smoking cessation
  2. Weight reduction
  3. Alcohol and coffee intake reduction
  4. Salt reduction
  5. Total and saturated fat reduction
  6. Increasing exercise
  7. Increasing fruit and veg
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3
Q

What should patients presenting with a BP of 140/90mmHg be offered to confirm diagnosis? (2)

A
  1. Ambulatory BP monitoring

2. Home BP monitoring

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4
Q

What is the BP of someone with stage 1 hypertension?

A

140/90mmHg and ambulatory average of 135/85mmHg or higher

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5
Q

Patients UNDER 80 with STAGE 1 hypertension are only treated if they have which other co-morbidities? (5)

A
  1. Target organ damage
  2. Cardiovascular disease
  3. Renal disease
  4. Diabetes
  5. 10 year cardiovascular risk >20%
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6
Q

If a patient under 40 presents with stage 1 hypertension and has no other co-morbidities, what further investigations should be done?

A

Causes of secondary hypertension

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7
Q

How are patients UNDER 80 with STAGE 1 hypertension with no other co-morbidities treated?

A

Lifestyle advice only

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8
Q

All patients with STAGE 2 hypertension should be treated. What is the BP of someone with STAGE 2 hypertension?

A

> 160/100 (ambulatory >150/95)

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9
Q

What should you do if someone has a clinic blood pressure over 180 systolic or over 110 diastolic?

A

TREAT PROMPTLY

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10
Q

What is the target clinic BP of someone with STAGE 1 hypertension?

A

140/90

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11
Q

What is the target home BP of someone with STAGE 1 hypertension?

A

135/85

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12
Q

What is the target clinic BP of someone with STAGE 1 hypertension and cardiovascular disease, diabetes in the presence of kidney, eye or cerebrovascular disease?

A

130/80

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13
Q

When treating hypertension, how long should treatment be tried for to see if it is effective?

A

4 weeks

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14
Q

What is the first line treatment for hypertension in a white person under 55?

A

ACE Inhibitor

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15
Q

First line HPT: What is an option if the ACE inhibitor is not tolerated?

A

Angiotensin Receptor Blocker

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16
Q

First line HPT: What is an option if neither the ACE inhibitor nor the ARB are tolerated?

A

Beta blocker

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17
Q

What is the first line treatment for hypertension in a person over 55 or a black person?

A

Calcium channel blocker

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18
Q

First line HPT >55: What is an option if the calcium channel blocker is not tolerated?

A

Thiazide-like diuretic

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19
Q

What is the second line treatment for hypertension in a white person under 55?

A

ACE inhibitor + Calcium Channel Blocker (or thiazide-like diuretic)

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20
Q

What is the second line treatment for hypertension in a person over 55 or a black person?

A

Calcium Channel Blocker (or thiazide-like diuretic) + ACE inhibitor

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21
Q

Is it advisable to give a Beta-blocker together with a thiazide-like diuretic to treat hypertension in those under 55 or white?

A

NO

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22
Q

What is the third line treatment for hypertension in all patients?

A

ACE Inhibitor + Calcium Channel Blocker + Thiazide-like diuretics

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23
Q

What must you seek if the patient does not respond to third-line antihypertension treatment?

A

Specialist advice

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24
Q

What are the options when third-line antihypertension treatment fails?

A

1) Add low dose spironolactone

2) Increase the dose of the thiazide-like diuretic

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25
If a patient does not tolerate an increased in their thiazide-like diuretic, what 2 other options can be considered?
1. Alpha blocker | 2. Beta blocker
26
Unless contra-indicated, what should all patients with established cardiovascular disease receive?
Aspirin
27
As well as aspirin, which other drug is used in patients with established or to prevent cardiovascular disease?
Statin
28
Is there evidence for the use of aspirin as primary prevention?
No
29
What is the blood pressure target for patients over 80?
Clinic: 150/90 Home: 145/85
30
What is the target blood pressure for patients with diabetes?
140/80
31
What is the target blood pressure for patients with diabetes in the presence of kidney, eye or cererbovascular disease?
130/80
32
Which antihypertensive is recommended in patients with diabetes?
ACE inhibitor
33
When can pregnancy women develop hypertension?
In the latter half
34
What are the 3 treatment options for hypertension in pregnancy?
1. Labetalol 2. Methyldopa 3. MR Nifedipine (unlicensed)
35
What is the target BP of pregnant women with chronic hypertension?
<150/100
36
What is the target BP of pregnant women with chronic hypertension and target organ damage / women with chronic hypertension who have given birth?
<140/90
37
Which medication are pregnancy women at risk of pre-eclampsia recommended to take?
Aspirin from week 12 until the baby is born
38
How long after birth should antihypertensives be stopped in women with gestational hypertension?
2 days
39
If blood pressure is reduced too quickly in a hypertensive crisis, what is there a risk of?
Reduced organ perfusion leading to cerebral infarction, blindness, deterioration in renal function, myocardial ischaemia
40
What is a hypertensive emergency defined as?
Severe hypertension with acute damage to target organs
41
During a hypertensive crisis, prompt IV treatment is needed. What are the options? (7)
1. Sodium nitroprusside 2. Nicardipine 3. Labetalol 4. GTN 5. Phentolamine 6. Hydralazine 7. Esmolol
42
If BP is >180/110 and no acute organ damage, this is defined as hypertensive urgency. What is the treatment?
Oral antihypertensives
43
For the treatment of resistance hypertension, can the vasodilator hydralazine be used alone?
No, must be as an adjunct otherwise causes tachycardia and fluid retention
44
Which drug which can be used as an adjunct in resistant hypertension is not suitable for females?
Minoxidil
45
Which class of drug used as options in stage 4 hypertension must be used with caution because they drop blood pressure very quickly?
Alpha blockers
46
What are the indications of ACE Inhibitors? (4)
1. Heart Failure 2. Hypertension 3. Diabetic nephropathy 4. Prophylaxis of cardiovascular events
47
Which drug are ACE inhibitors usually combined with in heart failure?
Beta blockers
48
Which drugs should be discontinued before starting treatment with ACE inhibitors for heart failure?
1. Potassium supplements | 2. Potassium sparing diuretics
49
Providing serum potassium is monitored, which drug can be used with an ACE inhibitor at a low dose for the treatment of heart failure?
Spironolactone
50
If a patient with heart failure is already taking a loop diuretic and they are started on an ACE inhibitor, what can be a profound effect?
First dose hypotension - may need to initiate under specialist supervision as temporary withdrawal of the diuretic can cause pulmonary oedema
51
What must be monitored before starting treatment with an ACE inhibitor? (2)
1. Renal function | 2. Electrolytes
52
What effect do ACE inhibitors have on serum electrolytes?
Hyperkalaemia
53
A specialist must be involved in initiating ACE inhibitors in patients with which impairment?
Kidney
54
Concomitant treatment with ACE inhibitors and which other drug increases the risk of renal impairment?
NSAIDs
55
Concomitant treatment with ACE inhibitors and which other drug increases the risk of hyperkaleamia?
Potassium sparing diuretics
56
Is it safe for patients with renal artery stenosis to take ACE inhibitors?
No, they should not take them
57
Is it safe for patients with renovascular disease to take ACE inhibitors?
No, but they can be used if there is no other option
58
If a patient is taking a loop diuretic at which dose, the ACE inhibitor should be introduced under specialist supervision?
Furosemide 80mg or equivalent
59
ACE inhibitors can cause a persistent dry cough, why can't ARBs also cause it?
They do not inhibit the breakdown of bradykinin
60
Which renin inhibitor is an option in hypertension?
Aliskerin
61
Why is a combination of 2 drugs affecting the RAAS not advised? (3)
1. Hypotension 2. Hyperkalaemia 3. Renal impairment
62
In which organs do bete-blockers block the beta-adrenoceptors? (5)
1. Heart 2. Peripheral vasculature 3. Liver 4. Lungs 5. Pancreas
63
Give an example of a really water soluble beta blocker
Atenolol
64
Which beta blocker is less likely to cause the side effect of nightmares? Why?
Atenolol. It is less likely to cross the BBB due to low lipid-solubility
65
How are water soluble beta-blockers excreted?
By the kidneys, Dose adjustment in renal failure sometimes necessary
66
Give 2 examples of beta blockers with an intrinsically long duration of action, allowing for once daily dosage
1. Atenolol | 2. Bisoprolol
67
Why are beta blockers contra-indicated in patients with second or third degree heart block?
They slow heart rate and depress the myocardium
68
As well as in patients with heart block, who else are beta-blockers contraindicated in?
Worsening unstable heart failure
69
Why should beta-blockers be avoided in patients with a history asthma?
Can precipitate bronchospasm
70
Where necessary, can patients with controlled asthma or COPD receive beta blockers?
Yes
71
Give 4 examples of caridoselective beta blockers with less of an effect on airway resistance
1. Atenolol 2. Bisoprolol 3. Nebivolol 4. Metoprolol
72
Give 3 side effects of beta-blockers
1. Coldness of the extremities 2. Sleep disturbance including nightmares 3. Fatigue
73
Affecting carbohydrate metabolism, what can beta-blockers cause in patients with or without diabetes?
Hypoglycaemia or hyperglycaemia
74
In diabetics, what can beta blockers mask?
Symptoms of hypoglycaemia such as tachycardia and tremor
75
Why are beta blockers effective in angina?
Reduce cardiac work and improve exercise tolerance
76
Is it advised to stop taking beta blockers suddenly in angina?
No, gradual dose reduction
77
If a beta blocker is used with which drug, can heart failure be precipitated in established ischaemic heart disease?
Verapamil
78
Which drug can beta blockers be used with in AF, especially in patients with thyrotoxicosis?
Digoxin
79
Which beta blocker is licensed for mild to moderate heart failure in patients over 70?
Nebivolol
80
Before which operation are beta blockers used?
Thyroidectomy
81
What are some other uses of beta blockers?
1. Migraine prophylaxis 2. Anxiety 3. Glaucoma
82
What are the symptoms of overdose with beta blockers? (3)
1. Lightheadedness 2. Syncope 3. Dizziness`
83
Which 2 calcium channel blockers must be avoided in heart failure?
1. Verapamil | 2. Diltiazem
84
What is verapamil used to treat? (3)
1. Angina 2. Hypertension 3. Arrythmias
85
Verapamil is a highly negatively inotropic calcium channel blocker. What does it reduce?
1. Cardiac output | 2. Heart rate
86
Can Verapamil be used with beta blockers?
No
87
What is a common side effect of Verapamil?
Constipation
88
Does nifedipine have much influence on the myocardium?
No, more on the vessels - smooth muscle relaxation and dilation of coronary vessels
89
Can nifedipine precipitate heart failure?
No
90
Which other calcium channel blockers resemble nifedipine in the way they act? Peripherally, used to treat angina and hypertension
1. Amlodipine 2. Felodipine 3. Nicardipine
91
Give 3 side effects of calcium channel blockers. All become less obtrusive after a few days
1. Flushing 2. Headache 3. Ankle swelling
92
Which calcium channel blocker must be used with caution with beta blockers?
Diltiazem
93
Give 8 signs of calcium channel blocker overdose
1. Nausea 2. Vomiting 3. Dizziness 4. Agitation 5. Confusion 6. Coma 7. Metabolic acidosis 8. Hyperglycaemia
94
Do standard release preparations of diltiazem need to be prescribed by brand?
NO
95
Do modified release preparations of diltiazem need to be prescribed by brand?
YES
96
What effect can diuretics have on electrolytes?
Hypokaleamia
97
Which type of diuretics have a greater impact on potassium loss?
Thiazide
98
If a patient is taking diuretics and there is a concern over potassium loss, what else can be prescribed? This is seldom necessary in the routine treatment of hypertension
1. Potassium sparing diuretics | 2. Potassium supplements
99
In hepatic failure, what can hypokalaemia precipitate?
Encephalopathy
100
In which group of people should lower initial doses of diuretics be used?
Elderly `
101
Diuretics should not be routinely prescribed for simple oedema. Which measure can be taken instead? (3)
1. Raising legs 2. Increased movement 3. Stockings
102
Which 3 conditions can thiazides exacerbate?
1. Gout 2. Diabetes 3. Systemic lupus
103
What should be monitored with use of thiazide diuretics?
Electrolytes
104
What should be monitored both at baseline and during treatment with ARBs? (2)
1. Renal function | 2. Electrolytes
105
What should be monitored both at baseline and during treatment with ACE inhibitors? (2)
1. Renal function | 2. Electrolytes
106
When treating hypertension, when should the first dose of an ACE inhibitor be given?
At bedtime

BNF (28 decks)

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