choosing hypertensive treatment Flashcards
Under 55, not african carribean step 1.
- ACE inhibitor (cheapest), if not tolerated (e.g due to cough) offer Ang II Receptor Blocker ARB.
Do not combine ACE inhibitor and ARBs (no better outcome, more side effects)
Under 55, not african carribean step 2.
If BP still not well controlled, offer CCB with step 1.
If CCB not suitable (e.g. due to oedema or intolerance) offer Thiazide-like drug with step 1.
Under 55, not african carribean step 3.
Before considering, ensure step 2 is optimal tolerated doses. If 3 drugs required, offer step 1: (ARB or ACE inhibitor), with a CCB and a Thiazide like diuretic
Over 55, or African Carribean (any age) step 1
step 1: Calcium Channel Blocker
If not suitable (e.g. oedema or intolerance) offer Thiazide-like diuretic like Indapimide
Over 55, or African Carribean (any age) step 2
Consider addition of ARB in preferance to ACE inhibitors, in combination with step 1.
Why not start Over 55, or African Carribean (any age) with ACE inhibitor or ARB?
These group of people have naturally lower Renin levels, so targeting this mechanism is not optimal.
What needs to be considered before adding or changing a drug?
Check adherence and compliance to treatment, and if adding a drug, make sure at optimal tolerated dose.
What is the guideleines for Hypertensive pregnant women?
Can either have Pre-eclampsia (with protein in urine) or Gestational Hypertension (without protein in urine).
Aim is to keep BP lower than 150/100 mmHg and below 140/90 mmHg if there is risk or end organ damage.
ACE and ARB and diuretics are contraindicated.
Beta blocker may be used instead and a CCB may be added if required.
Who are the people where Beta Blockers are first line treatment?
Pregnant, women of child bearing potential, younger people, those with intolerance to ACE and ARB, people with evidence of increased sympathetic drive.
With Beta blocker first line, what is the second drug that can be added if necessary?
CCB
