CV HTN Flashcards
whats stage 1 htn?
clinical BP: 140/90-160/100mmHg
or
ABPM: 135/85-149/94mmHg
for stage 1 htn start drug tx in which 4 groups of pts under 80y?
kidney disease,
diabetes,
CVD,
QRISK >/= 10%
for stage 1 htn start drug tx AND give lifestyle advice in which group of pts under 60y?
pts with <10% risk of CVD in 10 years
for stage 1 htn start drug tx in which pts OVER 80y?
BP > 150/90
whats stage 2 htn?
clinic BP: 160/100-180/120mmHg
or
ABPM: >150/95mmHg
high risk. treat all pts
whats stage 3 htn?
> 180/120mmHg
medical emergency! hospital asap as hypertensive crisis
HYPERTENSION TREATMENT
PATIENTS <55 or with T2DM?
Step 1?
Step 2?
Step 1: ACE-I or ARB (in T2DM afro-caribbean pts ARB>ACE-i preferred)
Step 2: ACE-I/ARB+ CCB OR TLD
HYPERTENSION TREATMENT
PATIENTS >55/AFRO-CARIBBEAN?
Step 1?
Step 2?
Step 1: CCB
Step 2: CCB+ ACEi/ARB/TLD in HF
for ALL HTN pts, what is step 3 and 4
Step 3: ACE-I/ARB + CCB + TLD
Step 4:
if Potassium <4.5mmol/L= low dose spironolactone
if Potassium >4.5mmol/L= alpha/beta-blocker
what two drug classes not recommended ofr use together in htn
acei and arb
whats a reason acei may be swapped to arb
dry cough se
why may ccb not be well tolerated thus witched to tld
oedema se
when to take perindopril for htn
30-60 mins before food
ACE-INHIBITORS- ramipril, enalapril, lisinopril and perindopril
SIDE EFFECTS?
CHHAReD
Cough
Hyperkalaemia
Hepatic failure
Angioedema
REnal impairment
Dizziness & headaches
angioedema is swelling of what
eyes
lips
genitals
hands
feet
ARB: Candesartan/Irbesartan/Losaratan
SEs?
Same SEs as ACE-i, except no cough and angioedema!
ACE-INHIBITOR INTERACTIONS?
increased risk of what 3
renal failure
hyperkalaemia
volume depletion
a se of acei is renal impairment so giving drugs that increase this risk such as X,Y,Z -> renal failure
arbs
k-sparing diuretics
nsaids
acei increase risk of hyperkalaemia so giving them with drugs that increase K+ lvls such as… -> hyperkalemia
BHANK
bb
heparins
arbs
nsaids
K sparing diuretics
and trimethoprim
which drug class interacts w ACEi to -> volume depletion
diuretics
ACEi can increase plasma levels of what ion
Lithium
acei and arbs -> inc conc of Li, major interaction as can -> Li toxicity
why are cardio selective beta blockers better for asthma
less likely to cause bronchospasms
which bbs are cardioselective? BAtMAN
Bisoprolol, Atenolol, Metoprolol, Acebutolol & Nebivolol
water soluble beta blockers are less likely to cross BBB -> less nightmares. examples
Water CANS
Celiprolol, Atenolol, Nadolol & Sotalol
INTRINSIC SYMPATHOMIMETIC BBs are less likely to cause cold extremities
examples? Ice PACO
Pindolol, Acebutolol, Celiprolol & Oxprenolol
4 main SEs of bb?
braducardia/ HF
blunts effects of hypOglycaemia
can cause hyperglycaemia
bronchospasms
why should you NOT give bb with amiodarone/ digoxin/ RL CCBs?
can worsen bradycardia and cause HF
bb blunt effects of/ mask hypoglycaemia. which symptoms?
sweating
palpitations
tremor
a SE of bbs is bronchospams thus contraindicated in asthmatic pts. why?
blocks beta receptors on smooth muscle causing bronchospasm
asthma ‘relaxes’ smooth muscle!
2 main interactions with bb
- digoxin: can cause heart block as disrupts impulses that control beating of heart muscle
- any hypotensive drug!
what are the Dihydropyridine CCBs?
Amlodipine, Felodipine, Lacidipine, Lercanidipine & Nifedipine
what are the Rate-limiting CCBs?
Diltiazem & Verapamil
4 SEs of CCBs?
Dizziness
Gingival Hyperplasia- enlarged gums
Vasodilatory: flushing/headaches/ankle swelling: more so in dihydro
Complete AV block- more so in R-L
in dihydropyridines what to avoid? interaction food
grapefruit juice
HYPERTENSION- PREGNANCY
High risk of developing pre-eclampsia?
Kidney disease/diabetes/autoimmune disease/hypertension (K-HAD inc risk of pre-eclampsia)
if pt taking primary prevention in preg eg statin, acei/ arb what to do?
stop as should be avoided!!
if pregnant pt at high risk of developing pre eclampsia, what drug to give from week 12 of pregnancy till birth
aspirin
HYPERTENSION- PREGNANCY
what the first and second line if Blood pressure> 140/90mmHg?
1: Labetalol (with food)
2: Nifedipine / Methyldopa
aim for 135/85mmHg
can give with aspirin as pregnant pt w HTN are at high risk of pre eclampsia and would need tx for both
HYPERTENSION TARGETS- CLINICAL AND AMBULATORY
clinical and ambulatory difference? C-A= 5
<80years?
140/90mmHg (clinical)
135/85 (ambulatory)
HYPERTENSION TARGETS- CLINICAL AND AMBULATORY
clinical and ambulatory difference? C-A= 5
> 80years?
150/90mmHg (clinical)
145/85 (ambulatory)
HYPERTENSION TARGETS- CLINICAL AND AMBULATORY
clinical and ambulatory difference? C-A= 5
Renal Disease?
140/90mmHg (clinical)
HYPERTENSION TARGETS- CLINICAL AND AMBULATORY
clinical and ambulatory difference? C-A= 5
Pregnancy/Type 1 Diabetes?
135/85mmHg (clinical)
which drugs may cause hypERtension?
clever chemists never liked cheeky vasoconstrictors
coc
ciclosporin
nsaids
leflunomide
cortiocosteroids
venlafaxine
which drugs may cause hypOtension
antihypertensives always adore night times
alpha blockers
arbs
acei
nitrates