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Roomies Collab Deck 1: Infectious Disease and CV > Hypertension > Flashcards

Hypertension Flashcards

1
Q

HTN is a major risk factor for which conditions? (6)

A
  1. Stroke
  2. MI
  3. HF
  4. CKD
  5. Cognitive decline
  6. Premature death
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2
Q

HTN is more common among which demographics? (3)

A
  1. Advanced age
  2. Women between 65-74
  3. Black African or African-Caribbean

Other risk factors include social deprivation, lifestyle factors, anxiety, and emotional stress.

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3
Q

What lifestyle advice should be given to patients with suspected or diagnosed HTN?

A
  1. Regular exercise
  2. Healthy diet
  3. Low dietary sodium
  4. Reduced alcohol intake (if excess)
  5. Discourage excessive consumption of coffee and other caffeine-rich products
  6. Smoking cessation
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4
Q

Patients presenting with blood pressure of ___/___ or higher when measured in clinic should be followed up to confirm diagnosis

A

140/90

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5
Q

How are patients with high blood pressure readings in clinic followed up? (2)

A

Either ambulatory blood pressure monitoring (ABPM)

OR

Home blood pressure monitoring if ABPM is unsuitable

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6
Q

Stage 1 HTN is classified as clinic BP between ___/___ and ___/___ OR ambulatory daytime average or home BP average of ___/___ or higher.

A

clinic blood pressure of between 140/90 mmHg and 160/100 mmHg

ambulatory daytime average or home blood pressure average of 135/85 mmHg or higher.

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7
Q

For patients under 80 yo with Stage 1 HTN, treatment should be discussed if what is also present? (5)

A
  1. Target-organ damage eg. LVH, CKD, hypertensive retinopathy
  2. Established CVD
  3. Renal disease
  4. DM
  5. 10 year CV risk of 10% or higher
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8
Q

When should anti hypertensive drug treatment be considered in addition to lifestyle advice for adults under 60 yo with Stage 1 HTN?

A

If they have an estimated 10 year CV risk below 10%

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9
Q

In addition to antihypertensive treatment, how should patients under 40 yo with Stage 1 HTN be managed?

A

Consider seeking specialist advice for evaluation of secondary causes

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10
Q

When should antihypertensive drug treatment be considered in addition to lifestyle advice in people aged over 80 yo with Stage 1 HTN?

A

If clinic BP is over 150/90

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11
Q

Stage 2 hypertension is a clinic blood pressure of between ___/___ mmHg and ___/___ mmHg, and ambulatory daytime average or home blood pressure average of ___/___ mmHg or higher.

A

Stage 2 hypertension is a clinic blood pressure of between 160/100 mmHg and 180/120 mmHg

ambulatory daytime average or home blood pressure average of 150/95 mmHg or higher.

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12
Q

How are patients with Stage 2 HTN managed?

A

Treat all patients who have stage 2 hypertension, regardless of age

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13
Q

Severe HTN is a clinic systolic blood pressure of ___ mmHg or higher, or a clinic diastolic blood pressure of ___ mmHg or higher.

A

clinic systolic blood pressure of 180 mmHg or higher, or a clinic diastolic blood pressure of 120 mmHg or higher

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14
Q

How is severe HTN managed?

A

Treat promptly, same-day specialist referral if signs of end-organ damage

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15
Q

Under which conditions, are patients with HTN referred for same day specialist assessment? (3)

A

Clinic BP of 180/120 or higher AND

  1. Signs of retinal hemorrhage or papilledema (accelerated HTN)
  2. Life-threatening symptoms (eg new onset confusion, chest pain, signs of HF or AKI)

OR
3. If pheochromocytoma is suspected

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16
Q

How should patients be managed who have severe HTN but no symptoms or signs indicating same-day referral?

A

Carry out investigations for target organ damage ASAP

If target organ damage is identified, consider starting antihypertensive drug treatment immediately without waiting for the results of ambulatory or home BP monitoring

If no target organ damage is identified, repeat clinic BP measurement within 7 days

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17
Q

Does CV risk need to be assessed in all patients with confirmed HTN?

A

Yes

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18
Q

What factors are used to determine CV risk in patients with confirmed HTN? (9)

A
  1. Glycated hemoglobin
  2. Electrolytes
  3. Creatinine
  4. Estimated GFR
  5. Total and HDL cholesterol
  6. Test for presence of proteinuria
  7. Test for presence of hematuria
  8. Test for presence of hypertensive retinopathy
  9. 12-lead ECG
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19
Q

What must be done before aspirin can be given to patients with CV disease?

A

High blood pressure must be controlled

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20
Q

Aspirin is recommended for which patients with established CV disease?

A

All patients with established CV disease (unless contraindicated)

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21
Q

What is the target BP for patients over 80 yo?

A

Clinic BP below 150/90
(vs 140/90 for under 80 yo)

Home/ambulatory below 145/85
(vs 135/85 for under 80 yo)

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22
Q

What is the target BP for patients under 80 yo?

A

Clinic BP below 140/90
(vs 150/90 for over 80 yo)

Home/ambulatory below 135/85
(vs 145/90 for over 80 yo)

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23
Q

If ACE inhibitors are not tolerated, for example due to cough, which drug should be offered instead?

A

ARB

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24
Q

Can ACE inhibitors and ARBs be used together in the treatment of HTN?

A

No

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25
Q

When choosing antihypertensive drug treatment for adults of black African or African–Caribbean family origin, consider an [ACEi/ARB], in preference to an [ACEi/ARB]

A

Consider an ARB in preference to an ACEi

26
Q

If a CCB is not tolerated, for example due to edema, offer a ______ instead

A

Thiazide-like diuretic

27
Q

If starting or changing diuretic therapy for HTN, offer a thiazide-like diuretic such as ______.

A

Indapamide

Preferred to conventional thiazide diuretics like bendroflumethiazide or hydrochlorothiazide

28
Q

How are patients with isolated systolic HTN (SBP of 160 or more) managed?

A

Same treatment as patients with both systolic and diastolic BP

29
Q

What are the steps for drug treatment in patients with HTN and DM II (any age or origin)? (4)

A
  1. ACEi or ARB
  2. Add CCB or thiazide-like diuretic
    * offer a thiazide-like diuretic if there is evidence of HF
  3. Offer an ACEi/ARB, CCB, and thiazide-like diuretic
  4. Confirm BP using ABPM, assess for postural hypotension and discuss adherence; if further treatment is required for resistant HTN, consider seeking specialist advice OR the addition of low dose spironolactone (unlicensed) if potassium is 4.5 or less OR an alpha/beta blocker if potassium is greater than 4.5
30
Q

What are the steps for drug treatment in patients with HTN WITHOUT DM II who are 55 yo or younger and NOT of black African or African-Caribbean origin? (4)

A

(Same as algorithm for patients with DM)

  1. ACEi or ARB
  2. Add CCB or thiazide-like diuretic
    * offer a thiazide-like diuretic if there is evidence of HF
  3. Offer an ACEi/ARB, CCB, and thiazide-like diuretic
  4. Confirm BP using ABPM, assess for postural hypotension and discuss adherence; if further treatment is required for resistant HTN, consider seeking specialist advice OR the addition of low dose spironolactone (unlicensed) if potassium is 4.5 or less OR an alpha/beta blocker if potassium is greater than 4.5
31
Q

What are the steps in treatment of HTN in patients WITHOUT DM II who are over 55?

A
  1. CCB
  2. Add ACEi, ARB, or thiazide-like diuretic
  3. Offer an ACEi/ARB, CCB, and thiazide-like diuretic
  4. Confirm elevated BP, assess for postural hypotension, discuss adherence; if further treatment is required, consider seeking specialist advice or low dose spironolactone (unlicensed) if potassium is 4.5 or less OR alpha/beta-blocker if potassium is greater than 4.5
32
Q

What are the steps in treatment of HTN in patients WITHOUT DM II who are over black African or African-Caribbean of any age?

A
  1. CCB
  2. Add ACEi, ARB, or thiazide-like diuretic
  3. Offer an ACEi/ARB, CCB, and thiazide-like diuretic
  4. Confirm elevated BP, assess for postural hypotension, discuss adherence; if further treatment is required, consider seeking specialist advice or low dose spironolactone (unlicensed) if potassium is 4.5 or less OR alpha/beta-blocker if potassium is greater than 4.5
33
Q

When using further diuretic therapy for step 4 of resistant HTN management, what should be monitored?

A

Blood Na, K, and renal function within 1 month of starting treatment; repeat as needed thereafter

34
Q

What is the aim of treatment of HTN in patients with DM?

A

Lowering blood pressure reduces the risk of macrovascular and microvascular complications

35
Q

What is the target BP in patients with HTN and DM I?

A

135/85 or less UNLESS the adult has albuminuria or 2 or more features of metabolic syndrome, in which case it should be 130/80 or less

36
Q

What are the features of metabolic syndrome? (3)

A

Obesity
DM
HTN

37
Q

What is the target BP for a patient with DM I and 2 or more features of metabolic syndrome?

A

130/80 or less

38
Q

What is the drug of choice for treating HTN in patients with DM I?

A

ACEi or ARB

39
Q

What is the target BP for patients with DM II and HTN who are over 80 yo?

A

Below 150/90

40
Q

What is the target BP for patients with DM II and HTN who are under 80 yo?

A

Below 140/90

41
Q

What is the target BP for patients with renal disease (CKD) and HTN?

A

Below 140/90

42
Q

What is the target BP for patients with renal disease (CKD) and HTN and DM II (or urine albumin:Cr ratio >70)?

A

Below 130/80

43
Q

What is the cutoff for diagnosis of gestational HTN vs chronic HTN?

A

Whether or not it is present before 20 weeks

44
Q

What is pre-eclampsia?

A

HTN in pregnancy (>140/90) accompanied by features of multi-organ involvement eg proteinuria

45
Q

What are the symptoms of pre-eclampsia? (5)

A
  1. Severe headache
  2. Problems with vision
  3. Severe pain below ribs
  4. Vomiting
  5. Sudden swelling of hands, feet, or face
46
Q

Does HTN in pregnancy require specialist care?

A

Yes, for pregnant women with chronic HTN, gestational HTN, or pre-eclampsia

47
Q

What are the risk factors for pre-eclampsia? (5)

A
  1. CKD
  2. DM
  3. Autoimmune disease
  4. Chronic HTN
  5. HTN during a previous pregnancy
48
Q

What medication is prescribed to pregnant women with a high risk of developing pre-eclampsia?

A

Aspirin (unlicensed) from week 12 of pregnancy until the baby is born

49
Q

What are the moderate risk factors for developing pre-eclampsia?

A
  1. First pregnancy
  2. Greater than 40 yo
  3. Pregnancy interval greater than 10 years
  4. BMI >35 at first visit
  5. Multiple pregnancy
  6. Family history of pre-eclampsia

*women with more than one moderate risk factor are also advised to take aspirin (unlicensed) from week 12 until birth

50
Q

Which antihypertensive drugs are associated with congenital abnormalities? (3)

A
  1. ACEi
  2. ARBs
  3. Thiazides and thiazide-like diuretics
51
Q

What is the treatment of choice for hypertension during pregnancy?

A

Women with pre-eclampsia, gestational or chronic hypertension who present with a sustained blood pressure of 140/90 mmHg or higher should be offered antihypertensive treatment (target BP <135/85)

FIRST LINE:
- oral labetalol initially 100 mg BD

SECOND LINE:
- nifedipine (unlicensed)

THIRD LINE:
- methyldopa (unlicensed)

52
Q

What is the treatment of choice for women with a BP of 160/110 or greater who require critical care during pregnancy or after birth?

A

Immediate treatment with either:

  • oral or IV labetalol
  • IV hydralazine
  • oral nifedipine modified release

Target BP 135/85 or less

53
Q

What is the treatment of choice for women in a critical care setting with severe HTN or severe pre-eclampsia or if they have or have previously had an eclamptic fit?

A

IV magnesium sulfate

*Consider intravenous magnesium sulfate in severe pre-eclampsia if birth is planned within 24 hours

54
Q

Should antihypertensive treatment be continued after birth in women treated for HTN in pregnancy?

A

If required, with dose adjustment according to blood pressure

55
Q

Can methyldopa given for HTN in pregnancy be continued after birth?

A

Should discontinue within 2 days and switch to an alternative antihypertensive

56
Q

Does the use of antihypertensives interfere with breastfeeding?

A

No

57
Q

What is the antihypertensive drug of choice for breastfeeding women NOT of black African or African-Caribbean origin?

A

Enalapril

Monitor maternal renal function and serum potassium

58
Q

What is the antihypertensive drug of choice for breastfeeding women of black African or African-Caribbean origin?

A

Consider nifedipine or amlodipine instead of enalapril

59
Q

In the post-natal period, if blood pressure is not controlled with a single drug, what should be offered?

A

Consider a combination of nifedipine (or amlodipine) and enalapril

If ineffective, consider adding labetalol or atenolol to the combination OR swapping one of the medicines being used for labetalol or atenolol

60
Q

What advice should be given to new mothers taking antihypertensive therapy? (2)

A
  1. Consider monitoring baby’s blood pressure
  2. Monitor baby for adverse reactions to antihypertensive therapy (drowsiness, lethargy, pallor, cold peripheries, poor feeding)
61
Q

What is the treatment regimen for women with hypertension in the postnatal period who are not breastfeeding?

A

Same treatment as standard population

62
Q

How long should women on antihypertensives remain on treatment in the postnatal period?

A

Treatment review 2 weeks after birth

Women treated for HTN during pregnancy should have a medical review 6-8 weeks after birth

Roomies Collab Deck 1: Infectious Disease and CV (84 decks)

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