control of BP + hypertension Flashcards
when should you suspect a patient has hypertension
if their clinic SBP is 140mmHg or higher and/or their DBP is 90mmHg or higher
confirm with ABPM average of 135/85mmHg or higher
what is primary hypertension
hypertension with no single cause identified, usually down to genetics/environment
90% of patients have primary hypertension
what is secondary hypertension
hypertension caused by renal or endocrine disease
10% of patients have secondary hypertension and it is typically more common in young patients so patients under 40 with hypertension should be referred to specialists
what are the risk factors for hypertension
lifestyle factors (obesity, stress, smoking, alcohol, stimulants inc cocaine, lack of exercise)
low birth weight, age, deprivation, genetics, co-morbidities
iatrogenic (steroids, phenylephrine in cold + flu meds)
what are potential outcomes of untreated hypertension
heart failure
coronary artery disease
aortic syndromes
stroke
kidney disease
peripheral artery disease
vascular dementia
visual impairment
what is stage 1 hypertension and how would you manage it
clinic BP of 140/90-179/119mmHg with ABPM of 135/85-149/94mmHg
offer lifestyle advice + consider drug treatment
if <40 refer to specialist + assess benefits/risks of treatment
what is stage 2 hypertension and how would you manage it
clinic BP of 180/120mmHg or higher with ABPM of 150/95mmHg or higher
offer lifestyle advice and drug treatment
if <40 refer to specialist and assess benefits/risks of treatment
how would you manage a caucasian patient with hypertension and type 2 diabetes
start on ACEi or ARB
add CCB if needed
add thiazide like diuretic if needed
how would you manage a hypertension patient with african family origin who is under 55 and does not have type 2 diabetes
ACEi or ARB
add CCB
add thiazide like diuretic
how would you manage a caucasian patient with hypertension who is over 55yrs and does not have type 2 diabetes
CCB
add ACEi or ARB
add thiazide like diuretic
(same treatment applies to black african patients with no type 2 diabetes)
what are the side effects of ACEi
dry cough
angioedema
make patients dry so need to stop meds during sick days where patient is not eating/drinking or losing fluids to vomiting/diarrhoea
what are the side effects of CCBs
leg swelling
dry mouth
bradycardia (non-dihydropyridine CCBs)
how do peripheral CCBs work?
peripheral CCBs = dihydropyridine CCBs e.g nifedpine, amlodiopine
bind L type Ca channels on smooth muscle cells in peripheral arteries to decrease contraction of vascular smooth muscle cells resulting in decreased vessel tone, TPR + afterload which overall decreases BP
how would you treat hypertension in pregnancy
labetalol (mixed alpha + beta blocker)
also methyldopa or nidefipine
stop ACEi/ARBs
what are side effects of thiazide like diuretics
hypokalaemia
hyponatraemia
how do ACEi work
competitively inhibit action of ACE to stop conversion of angiotensin I to angiotensin II which stops salt and water retention and inhibits vasoconstriction
how do ARBs work
competitively inhibit action of angiotensin II at angiotensin AT1 receptor
similar to ACEi - good alternative for those on ACE with dry cough
