Hypertension Flashcards
First line treatment in patient age <55 and not of
black African or African– Caribbean family origin / With T2DM
ACEi or ARB
First line treatment in patient age >55 / Afro-caribbean
CCB
Second line treatment
Add ACEi or ARB if already added CCB
Add CCB if already added ACEi or ARB
OR thiazide-like duiretic
Third line treatment
ACEi or ARB + CCB + thiazide-like duiretic
Fourth line treatment
Confirm resistant hypertension: confirm elevated BP with ABPM or HBPM, check for postural hypotension and discuss adherence.
Consider seeking expert advice or adding a:
• low-dose spironolactone if blood potassium level is ≤4.5 mmol/l
• alpha-blocker or beta-blocker if blood potassium level is >4.5 mmol/l
Seek expert advice if BP is uncontrolled on optimal tolerated doses of 4 drugs
BP target age <80 years:
- Clinic BP <140/90 mmHg
* ABPM/HBPM <135/85 mmHg
BP target age ≥80 years:
- Clinic BP <150/90 mmHg
* ABPM/HBPM <145/85 mmHg
BP target postural hypotension:
• Base target on standing BP
BP target frailty or multimorbidity:
• Use clinical judgement
Measure standing and sitting BP in people
with:
- type 2 diabetes or
- symptoms of postural hypotension or
- aged 80 and over.
In BP under 140/90 mmHg
Check BP at least every 5 years and more
often if close to 140/90 mmHg
Treatment for age >80 with clinic BP >150/90 mmHg:
• Offer lifestyle advice and consider drug treatment
Treatment for age <80 with target organ damage, CVD, renal disease, diabetes or 10-year CVD risk ≥10% and with clinic BP >150/90 mmHg:
• Offer lifestyle advice and discuss starting drug treatment
Treatment for age <60 with 10-year CVD risk <10% and with clinic BP >150/90 mmHg:
• Offer lifestyle advice and consider drug treatment
Treatment for age <40 with clinic BP >150/90 mmHg:
• Consider specialist evaluation of secondary causes and assessment long term benefits and risks of treatment
Treatment for 150/95 mmHg or more (stage 2)
Offer lifestyle advice and drug treatment
Age <40:
• Consider specialist evaluation of secondary causes and assessment long term benefits and risks of treatment
ACI Inhibitors list (4)
enalapril, lisinopril, perindopril and ramipril.
ACI Inhibitors common side effects
Persistent dry cough!
headaches, dizziness and a rash.
Angiotensin-2 receptor blockers (ARBs) list (5)
candesartan, irbesartan, losartan, valsartan and olmesartan.
ARB common side effects
dizziness, headaches, and cold or flu-like symptoms.
Calcium channel blockers (5)
amlodipine, felodipine and nifedipine.
also diltiazem and verapamil, are also available.
Calcium channel blockers side effects
headaches, swollen ankles and constipation.
You shouldn’t take … with …
grapefruit juice with calcium channel blockers
Contraindications to ACI Inhibitors
Pregnancy and breast feeding
Angioedema
