HTN and Cholesterol Flashcards
Stage 1 HTN defined as a clinic BP of >? and an ambulatory BP monitor daytime average of >?
Clinic BP >140/90
ambulatory BP >135/85
Stage 2 HTN defined as what?
clinic BP >160/100
ambulatory BP >150/95
Stage 3 HTN defined as what?
clinic systolic BP of 180 or more OR
clinic diastolic BP of 110 or more
Normally, you expect BP to dip at night. If there is a difference in daytime and night-time readings of <10% what diagnosis should you explore?
sleep apnoea
what 6 measures of lifestyle intervention should be offered to everyone with HTN?
- diet - high in fruit and veg and low in fat
- regular physical exercise - 30mins moderate aerobic exervcise 5-7 days a week
- reduce alcohol intake
- reduce dietary sodium intake
- smoking cessation
- weight reduction
HTN treatment should be offered to all people <80yrs old with stage 1 HTN and at lease one of which factors (5)
- target organ damage
- CVD
- renal disease
- DM
- 10 yr cardiovascular risk of >20% (lipid lowering therapy is given if 10yr risk >10%)
what is first line treatment of HTN in a patient who is <55yrs old and not of black African or African-carribean origin?
Ace inhibitor
or
ARB
what is first line treatment of HTN in someone over 55yrs or someone from black african or african-carribean family origin
calcium channel blocker
what is first line treatment for a T2DM patient with HTN?
Ace inhibitor or ARB
2nd then 3rd steps for someone <55 and not of black origin for treating HTN?
2nd CCB
3rd thiazide-like diuretic
2nd then 3rd steps for someone >55 or of black origin?
2nd ACE inhibitor or ARB
3rd thiazide-like diuretic
step 4 for everyone with HTN
if blood potassium <4.5 choose low-dose spironolactone
if blood potassium >4.5 choose alpha or beta blocker
Name 5 tests that should be offered to someone with HTN to check for cardiovascular risk and target organ damage
- Urine sample - to get an estimate of the albumin:creatinine ratio to check for protein in the urine
- urine dipstick to test for haematuria
- Blood sample - plasma glucose, electrolytes, eGFR, creatinine, serum total cholesterol and HDL
- examine fundi for presence of hypertensive retinopathy
- 12 lead ECG
what is particularly important to monitor in people taking ACE inhibitors?
eGFR - it should not drop by >25% after taking anti-hypertensives
Name 4 adverse effects of ACE inhibitors
- hypotension (particularly first dose hypotension)
- persistent dry cough
- hyperkalaemia
- they can cause or worsen kidney failure
- Rare = angioedema and anaphylactoid reactions
patients with what 2 conditions should ACEi be avoided in?
- renal artery stenosis
- AKI
- avoid in pregnant/breastfeeding women
What two drugs should be avoided being used alongside ACE inhibitors?
- potassium elevating drugs e.g. K+-sparing diuretics
2. NSAIDs - together they increase risk of nephrotoxicity
When/how often should renal function be tested when starting ACEi?
- before treatment
- 3 months after starting
- then annually
How can you assess CVD risk in people?
QRISK2 risk assessment tool
What percentage 10yr risk does someone need to have to be offered a statin?
10%
what cholesterol-lowering drug should be offered, and at what dose, as primary prevention of CVD?
Atorvastatin 20mg
what dose of atorvastatin should you start for a person with CVD?
80mg
how soon after starting statin treatment should you test cholesterol levels? What percentage of reduction should you ideally have reached?
after 3 months - aim for a greater than 40% reduction in non-HDL cholesterol.
what are the two most common adverse effects to statins?
headache
GI disturbance
what are the more serious but rarer side effects to statins
effects on muscles causing myalgia
the metabolism of statins is reduced by CYP3A4 inhibitors. What does this mean to the amount of statin that will be in the body if given with one of these?
it will increase as it is not being broken down. Could put patient at more increase of side effects
Name some drug interactions with statins
o Amiodarone o Diltiazem o Itraconazole o Macrolide antibiotics o Protease inhibitors o Grapefruit juice (however, one half of a grapefruit daily is unlikely to increase risk of adverse interactions or muscle injury)
if needing to give a macrolide antibiotic to a patient on statins, what is the best ting to do to avoid interaction?
stop the statin until the antibiotic course is finished
Can you continue to give atorvastatin to a patient also taking amlodipine?
yes but statin dose should not exceed 20mg
