HTN Flashcards
normal bp
stage 1,stage 2 and severe + a bpm
90/60-120/80 mmhg
clinical stage 1: 140/90+ (abpm - 135/85+)
stage 2: 160/100 (apbm 150/95)
severe: 180/11 + treat prompt
pre-eclampsia bp
sustained >140/90
severe h/a vision problem pain below ribs, von sudden swelling hands and feet
if high risk = chronic HT,CKD,DM, autoimmune disease , past pre-eclamptic pregnancy give aspirin (unlincesed week 12 till birth)
cardiac output calculation
CO=HR X SV
stage 1 treatment
1) lifestyle advice 1st line
2) consider if 80+ bp 180/90
3) or if under 80 but target organ damage i.e ckd, 10 year cvd risk>10%
dm and ckd
stage 2 tx
treat all above 160/100
risk factor
over 65,lots sat fats,afro-carribaean, diabetic ,limit exercise , lack fruit veg, smoke , no exercise
diagnosis htn
spyhghmanonmeter at least 2 readings usual wakinhrs
-confirm via abpm not clinical
lifestyle advice
relaxation, min 6hrs a day sleep, <6g salt, no more 14 units alohcol , reg exercise, less caffeine inc fruit and veg
bmi 20-25
treat underlying diabetes or dysleidesmiea, mediterannean diet
target bp in ckd oe diabetes
<130/80
1)HT before 1st 20 week gestation
2) ht after 20 weeks
3) ht after 20 weeks with organ damage
1)chronic htn
2) gestational diabetes
3) pre-eclampsia
what two drugs to avoid in diabetes
beta blocker and TZD cause hyperglycamesi
what is q risk
risk of cvd event next 10 yrs (%age smoking fh vmi diabetes cholesterol HDL/ af)
1st line HTN
age less than 55 /T2DM= acei (arb if not tolerated i.e due to dry cough)
r 55 and over and black: ccb (i.e amlodipine)/ (3rd if not tolerated or HFi.e chortalidone or indapamide)
2nd line HTN
dual therapy
for acei/arb (1st line ) +ccb or TRD(HF)
FOR ccb or trd +acei/arb
step 3 HTN
TRIPPLE THERPAY
A+C+T
step 4 if K+ <4.5
if >4.5
<4.5= low dose spironolactone
>4.5 alpha blockers or beta blockers
step 4 if K+ <4.5
if >4.5
<4.5= low dose spironolactone
>4.5 alpha blockers or beta blockers
htn in pregnancy 1st line and target
<135/85
1st line labetalol (c/I asthma or jaundice = hepatoxici)
alt = nifedipine mr (unlicensed) then methyldopa (unlincesed ) stop 2 days after brith
tx severe htn preg planned 24 hrs
IV magnesium sulfate
target bp
over 80 <150/90
under 80/ ren, DISESA <140/90
acr>70 IN RENAL DISEASE , diabetes in presence of kidney eye or cerebrovasc disease, establish artherosclerotic disease= <130/80
target bp dm
<140/90
high risk drugs :ACEI/ARBS
MOA
acei= inhibit conversion of angiotensin 1 to 2
arbs= block angiotensin 2 receptor (doesn’t inhibit breakdown of bradykinin)
dose of acei/arb
all OD except captopril (bd) and 1st dose at bedtime
- renoprotective in renal disease- ckd
nephrotoxic - cause aki
reduce egfr in afferent arteriole sick day rule- stop 24-48 hr in sickness after feeling better) prevent dehydration lead to Aki
- dont drink excessive fluid volumes
- avoid in pregnancy and renovascular disease i.e renal artery stenosis
monitor acei /arb
serum electrolyte (inc K+, CA2+AND DECREASE na+)
- renal function
bp after initial dose and 4 weeks after every dose change
when to monitor fluid electrolyte in acid and arb
every 1 - two weeks on initiation and 1-2 weeks after each dose change
s/e acei /arb
- dry irritating cough- after 8-12 weeks in acei (switch to arb)
- hyperkalaemia (inc risk ri or diabetes)
- water rentention
- cholestatic jaundice or marker liver impairment where enzyme 3x normal stop
- dizziness blurred vision faint- postural hypo
- renal stenosis abnormal rot
- aki - n/v / confusion anuria n/v
- angiodema
other s/e acei arb
oral ulcer, taste change, hypoglcyaemia
interaction with acei arb
increase plasma conc- lithium
hyperkaelaeima - had beans
nephrotoxcitiy and reduced egfr with nsaid
hypotension with diuretic (volume depletion)
central acting antihypertensives
methyldopa= drowsiness drivinh
clonidine= flushing
moxonidine
vasodilator antihypertensive
hydralazine s/e fluid retention tachycardia
minoxidil = tachycardia flurd retention and increase cardiac output
beta blockermoa
bloc beta adrenorecpetor in heart, peripheral vasculature, bronchi pancreas and liver
what antihypertensives to avoid pregnancy
acei arb , TRD ,TZD
severe htn tx preg >160/110
iv labetalol, iv hydralazine oral nifedipinem/r
name some special beta blockers
esmolol - htn peri operative ; short half life)
labetalol (preg; hepatoxic)
sotalol class 3 anti arrhythmic s/e tornadoes des pointes prolong Qt
s/e beta blockers
hyperglycaemia or hypoglycaemia
masks hypoglycaemia
bradycardia , fatigue, hypotnesion
c/ I beta blockers
bronchospasm with asthma (even in eye drops )
2) worsen unstable HF
3)2ND/3RD DEGREE heart block
4) severe hypo or bradycardia
-
interaction beta blocker
verapamil injection (systole and hypotension )- hyperglycaemia; avoid in diabetes/ high risk diabetes i.e tRD O TLD
type of beta blocker 4 TYPES
1) ice PACO
intrinsic sympathomimetic activity- pindolol acebutol (less bradycardia, less coldness of extremities)
celiprol oxprenolol
2) water CANS (water soluble less likely cross BBB; no sleep disturb or night mares) celiprolol, atenolol, nadolol , celiprolol
3) Be A MAN cardioselective less brochospasm ( okay for asthma under specialist - Bisoprolol, acebutol, metoprolol, atenolol , nevibolol
4) BACoN - intrinsically long duration action OD
bisoprolol, atenolol, celiprolol nadolol
name alpha blockers
doxazosin, terazosin, alfuzosin , tamsulosin
CCB moa and example of dihydropyridine
reduce force of contraction block calcium channels
nifedipine amolodopine felodopine
same brand of ccb
nifedipine
s/e of ccb
ankle swelling, flush , h/a , palpitation
what are rate limiting ccb
diltizem (prescribe by brand esp >60mg)
verapamil (causes constipation only rlccb licensed in arryhtmai
interaction ccb
enzyme inhibitor inc conc ie grapefruit juice
what anti hypertensive would u not prescribe with rl ccb
beta blocker as inc risk bradycardia and cardio depression
experience ankle swelling in amlodipine ?
switch to TRD
