Essential Hypertension Flashcards
Look for secondary HTN evaluation in Nephrology for secondary work up.
when does cough related to ACEi start?
within 1-2 weeks after starting but can start up to 6 months later. Non productive
how does the cough happen?
ACE metabolizes kinins and substance P and so ACEi will increase kinins and substance P which possibly induces bronchial irritation and cough.
How to stop the cough related to ACEi?
Stop ACE and takes 1 -4 weeks for cough to resolve. Changing to different ACEI will still cause cough to continue.
What if cough doesn’t go away after stopping ACEi?
need to look at other causes.
Goal BP for ppl >60
<150/90 and start therapy if above (per JNC 8)
Age <60 or CKD or DM2 BP goals
<140/90 or initiate therapy if above
Initial HTN treatment choice for blacks
thiazide or CCB alone or in combination. Acei/ARB not first line
initial HTN treatment choice for all ethnicities except black
thiazide, ACEi, ARB or CCB alone or in combo
All ethnicities w/ CKD, initial HTN tx choice
ACE or ARB alone or in combo with other classes
When to start combination therapy to treat HTN?
if pt’s BP is >160/100 or 20/10 above target or do not achieve goal on monotherapy need combo therapy.
FOR BOARDS: chlorthalidone may be preferred over HCTZ due to higher potency and longer duration of action
True (FOR boards) but be aware of chlorthalidone causing hyponatremia in real life.
When is spironolactone helpful
when pts have uncontrolled HTN despite 3 BP drugs and relatively contraindicated in men with potential antiandrogenic effects.
When can angioedema occur as a side effect of ACEi?
can occur anytime and this can happen 0 .5% IT is not dependent on dosage or type of ACEi.
what are the risk factors for angioedema related to ACEi?
African descent, female gender, smoking, use of NSAIDs. affects lips, tongue and face and upper airways. can affect intestines and result in abdominal pain and swelling and ascities
Does angioedema present with itching or urticaria?
NO. Can see hoarseness and strider if upper airways are affected.
why does angioedema happen with ACEI
because they inhibit ACE and so there’s elevated levels of bradykinin and so this is not histamine mediated. so fresh frozen plasma may be used since it contains ACE which degrades bradykinin but also may have a paradoxical effect too
What to do if someone needs to be on the cardioprotective effects of ACE and get angioedema
stop the ACEI and can start them on ARBS but there is a 1.5-10% rate of recurrence with angioedema in pts who were switched to ARBs. Recurrent angioedema is seen within 1 month of discontinuation of ACE i so may have a residual effect of ace i rather than ARB use.
how much does DASH DIET lower BP
8-14 SBP
weight loss helps HTN how?
reduction of BMI<25 and this can lower SBP by 5-20 per 10 kg loss
how much exercise does help HTN?
30/min day for 5-6 days/week lowers by 4-9 SBP
pts who have HTN >20/10 above goal should
have combination antihypertensive therapy started with 2 or more medications to reach their goal BP
Drugs that elevate BP?
NSAIDS Antidepressants (TCAs, doxepin) Steroids (prednisone) oral contraceptives decongestants (pseudoephedrine) Migraine medications (triptans and ergotamines) erythropoietin
what herbal supplement elevates BP
licorice (mimics aldosterone)
NSAIDS can cause injury
enhances renal vasoconstriction, induces interstitial nephritis, or causes glomerulonephritis (minimal change or membranous nephropathy).
