Hypertension Flashcards
Compare primary and secondary hypertension
Primary = no underlying cause. Secondary = caused by underlying health condition like kidney disease
Sx of hypertension?
Often none.
Optimal blood pressure?
120/80
Mild hypertension is 140/90, what is moderate?
160 /100
What is classified as severe hypertension?
180/110
Target BP for hypertensive patients?
140/90 or lower
Would you commence anti HT treatment if the patients BP was 170/100?
No. Usually only start if 180/110 or if isolated systolic HT
Name 2 substances that can increase BP and may exaggerate a BP reading
Caffiene and cigarettes
Which arm should you use to measure BP?
Once on each arm, then repeat on the arm with the highest measurement
Most accurate vs least accurate BP measuring tool?
Mercury is the best, then finger is the worst
First progression to Tx if the first line drug isn’t effective?
Add a second drug, then increase the dose of the first drug if needed
Which 2 classes of drugs can be teratogenic
ACEI and Sartans
CCBs can have what effect on a fetus?
Foetal hypoxia
Which 2 beta blockers are ok for use in pregnancy?
Labetolol and oxprenolol
2 first line anti-HTs for pregnancy?
Labetolol or methyldopa
Which beta blockers is excreted excessively in breast milk and should be avoided when breastfeeding?
Atenolol. The rest are ok
Which combination is better, ACE-I + CCB or ACE-I + ARB?
ACE-I + CCB. Second combo is contraindicated due to risk of renal issues
Verapamil + beta blocker combination is avoided. why?
Risk of heart block. Risk is less when verapamil is replaced with diltiazem
Thiazide diuretics are not recommended in which 2 conditions?
GOUT (increases Uric acid levels) and diabetes (causes hyperglycaemia)
Why can ACE-Is not be used with NSAIDs?
Causes a reduced GFR, leading to increased BP and kidney damage
Which drug class can cause a cough?
Ace inhibitors. Due to their ability to inhibit bradykinin breakdown
2 ADRs to watch for in ACE-Is?
Cough and angioedema (swelling of face and lips)
A patient on a diuretic or recently had diarrhoea / fluid loss is more likely to experience which ADR of ACE inhibitors?
First dose hypotension
Which class of CCBs do amlodipine and nifedipine belong to?
Dihydropyridines. Note the suffix -ipine
Diltiazem and verapamil are more selective for the peripheral vasculature. True or false?
False. More selective for heart
Name 2 non-dihydropyridines.
Verapamil and diltiazem
Which class of anti-HTs can cause reflex cardiac events such as tachycardia, angina or palpitations?
Short acting dihydropyridines like nifedipine. Because it is more selective for vasculature and has little cardiac activity.
B1 selective beta blockers?
Atenolol, metoprolol, bisoprolol
Which receptors is propranolol most selective for?
B1 and B2. Not selective
Labetolol is a non-selective beta blocker that also antagonises the A1 receptor. What effect does this cause?
Vasodilation
Why aren’t beta blockers first line agents in elderly patients?
Because they are less protective against strokes compared to the others
Why is label 9 needed on BBs?
Because your body compensates by producing more beta receptors. If you suddenly stopped, increased activity of all the receptors would cause rapid HR, angina, rebound HT, etc. Need to reduce over a few weeks
Why is precaution needed for BBs in diabetes?
Can mask signs of hypoglycaemic events such as tachycardia or tremors.
ADRs of beta blockers?
Bradycardia, hypotension, orthostatic hypotension, cold extremities, altered lipids, SLUDGE BBB
Name 2 ARBs
Irbesartan and candesartan
Which supplements and drugs need to be stopped before starting ARB Tx?
Potassium supplements and potassium sparing diuretics. Would cause hyperkalemia
ARB ADRs?
Dizzy, headache, hyperkalaemia, orthostatic hypotension, first dose hypotension, etc
If a patient‘s GFR was reduced by 25% after starting an ACE-I, would you stop Tx?
Generally not stopped unless decline is greater than 30%. Also need to ask about NSAID use.
