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Hypertension Flashcards

1
Q

What are the 3 methods of measuring hypertension

A

ABPM
HBPM
Clinical

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2
Q

What does it mean to have ‘established CVD’

A

Conditions affecting the heart or blood vessels such as angina, stroke

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3
Q

Target organs are

A

Heart
Kidney
Eye
Brain

Problems here can cause high BP

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4
Q

Recommended salt intake

A

<6g a day

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5
Q

What are secondary causes of hypertension

A

Renal disease
Endocrine

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6
Q

Whats the target clinical blood pressure for over 80s

ABPM

A

< 150/90 mmHg

< 145/85mmHg

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7
Q

Under 80s target clinical blood pressure

A

< 120/80 mmHg

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8
Q

Stage 1 clinical blood pressure and ABPM

A

140/90mmHg

135/85mmHg

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9
Q

Stage 2 clinical blood pressure and ABPM

A

160/100mmHg

150/95mmHg

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10
Q

Severe clinical BP

A

180mmHg systolic or 120 mmHg diastolic

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11
Q

Which readings are required to diagnose stage 1 and stage 2 hypertension

A

Both clinical and ABPM

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12
Q

Which readings would you require to diagnose stage 3 hypertension

A

Either systolic 180mmHg or 120mmHg diastolic

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13
Q

Target BP for diabetics with conditions affecting their vessels supplying the brain e.g., eye, kidney

A

130/80mmHg

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14
Q

Pregnant women taking antihypertensives should aim for the clinical reading of

A

135/85mmHg or less ABPM

< 140/90mmHg

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15
Q

Patients with CVD conditions and diabetes should aim for a target BP of

A

140/90mmHg

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16
Q

Whats persistent hypertension

A

High blood pressure at repeated clinic encounters

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17
Q

Accelerated hypertension is

A

Severe increase in BP greater than 180/120mmHg and often over 220/12mmHg WITH signs of

Retinal haemorrhage and/or papilledema. Usually associated with organ damage

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18
Q

A patient presents to you in the pharmacy with a blood pressure of 197/126mmHg with retinal haemorrhage

What is this and what would do you do?

A

Accelerated (malignant) hypertension

Refer to specialist on the same day!!!!!

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19
Q

Patients presenting to you with a blood pressures between 140/90 and 180/120 should be offered….

Whilst waiting for the results investigate…….

A

ABPM to confirm diagnosis. Otherwise HBPM

Investigate target organ damage and assess CVD risks using QRISK score

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20
Q

A patient presents with a BP of 129/87mmHg. Hes offered ABPM and investigated target organ damage and CVD risk. His results come back as no organ damage and no hypertension.

What do you do?

A

Measure BP every 5 years and more frequently if BP closer to 140/90

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21
Q

Stage 1 hypertension under 80s, do you offer them treatment?

A

Only if they have 1 or more:

  • target organ damage
  • Established CVD
  • Renal disease
  • Diabetes
  • 10% CVD risk

Otherwise just lifestyle

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22
Q

In < 40yrs with stage 1 hypertension investigate……

A

Secondary causes of hypertension such as thyroid

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23
Q

Under <60s stage 1 hypertension with less than 10% CVD risk offer……

A

Lifestyle advice and consider treatment

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24
Q

Stage 1 hypertension > 80s, do we give medication?

A

Yes

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25
Stage 2 hypertension, which ages would be given anti hypertensives
Treat all regardless of age (160/100mmHg)
26
Stage 3/ severe hypertension treat all by giving
IV anti hypertensive
27
A patient presents to you with a BP of 220/120mmHg but has no other symptoms. - same day referral (accelerated hypertension) - refer to the hospital immediately - refer to the GP - advise them to take more fluids
Refer to the hospital. Carry out investigations for target organ damage asap
28
A patient has accelerated hypertension and organ damage, hes still awaiting his home/ABPM results. what do you recommend?
Start antihypertensive immediately without waiting for results
29
A patient presents to you with accelerate hypertension but with no target organ damage. What do you recommend?
Repeat clinic BP within 7 days
30
In all patients with DIABETES and HYPERTENSION the first line is
ACEI or ARB regardless of family origin or age
31
Which is preferred in Caribbean origin? ACEi or ARBS
ARBs
32
Which Diuretic is preferred in hypertension, bendroflumethiazide or indapamide?
Indapamide unless already stable on bendro
33
Why are Antihypertensives beneficial in diabetic patients
Reduces risk of macro vascular complications
34
Diabetes macrovascular complications
CDV Increased risk of MI/stroke
35
Diabetes microvascular complications
Kidney problems Retinopathy Nephropathy
36
Hypertension with T2DM treatment:
1. ACEi or ARB - ACEi prevents macrovascular complications and helps kidney function 2. Add a CCB or a TLD 3. ARB/ACEi + CCB + TLD 4. Spironolactone 25mg if K+ <4.5mmol otherwise alpha blocker - doxasozin or BB
37
Hypertension treatment No diabetes Under 55 And not of black origin
1. ACEi or ARB 2. Add a CCB or a TLD 3. ARB/ACEi + CCB + TLD 4. Spironolactone 25mg if K+ <4.5mmol otherwise alpha blocker - doxasozin or BB
38
Whats the relationship of renin with age and origin
Lower levels of renin in older age (55+) and in black origin hence ACEi cant function as well so they arent used 1st line
39
Hypertension treatment Agee 55 or over or of black origin
1. CCB 2.CCB + ACEi/ ARBs/TLD 3. ACEi/ARB + CCB + TLD 4. 4. Spironolactone 25mg if K+ <4.5mmol otherwise alpha blocker - doxasozin or BB
40
Before moving onto step 4 anti hypertensives check:
Check for postural hypotension Confirm resistant hypertension at home/ABPM Discuss adherence
41
Give examples of BB used in 4th line antihypertensive treatment
Atenolol Bisoprolol
42
Can tamsulosin be added in 4th line antihypertensive treatment?
No Its an alpha blocker but used for BPH
43
Which CCB do we use in hypertension
Dihydropyridines- amlodipine
44
Why arent rate limiting CCB used in hypertension
They influence heart rate
45
Major SE of dihydropyridines How to respond?
Oedema Stop and give alternative
46
Why is spironolactone mot given if the K+ levels >4.5mmol/l
Hyperkalaemia risk with acei and spironolactone and both drugs have additive SE TLD may cancel it out as it causes hypokalaemia but still monitor
47
How do TLD affect K+ levels
Hypokalaemia
48
When taking a combination of antihypertensive you are at risk of
Hypotension
49
What time of day should you take diuretics
Morning
50
What time of day should you take ACEi
At night
51
When do you take amlodipine- time of day
Anytime
52
Measure standing and sitting BP if:
T2DM 80 or ocer Symptoms of postural hypotension
53
In T1DM with hypertension which CCBs are used
Long acting preparations such as MR nifedipine
54
T1DM and hypertension treatment:
1. ACEI or ARB start with low dose and titrate to max 2. Either: - BB -CCB - long acting only -Diuretics (low dose thiazide)+ BB combo 2nd line in any order as long as ACEi is 1st line
55
Do ACEi protect the kidney
Only in diabetic patients otherwise they could damage them
56
can BB be given in AV block
Caution in 1st degree AV block CI in 2nd and 3rd Degree AV block
57
BB contraindicated in the conditions:
2nd and 3rd degree AV block Prinzmetals angina Marked bradycardia Unstable HF
58
Whats the target BP in patients with diabetes and CKD or if creatinine ratio >70mg/mmol
< 130/80mmHg
59
Target BP in patients with renal disease
< 140/90mmHg
60
Can ACEi be used in renal impairment Why
with caution because ACEi cause hyperkalaemia and low CrCl increases the risk of hyperkalaemia
61
How does CrCl affect K+
Low CrCl increases hyperkalaemia risk
62
What are the drugs used in hypertension in pregnant patients
Labetalol MR nifedipine (unlicensed) Methyldopa (unlicensed)
63
Avoid Labetalol in pregnant patients with the conditions _____
COPD asthma Unstable HF
64
A pregnant patient is on methyldopa to control her hypertension. When would you stop this medication
2 days after birth and continue regular hypertension treatment
65
Whats used in severe hypertension in pregnant women
IV magnesium sulphate is used in critical care or severe hypertension
66
Whats the Labetalol dose in hypertensive pregnant women
100mg BD; dose increased at intervals of 14 days Usual dose 200mg BD; increased if necessary to Up to 400mg BD
67
Whats the max dose of labetalol use in hypertensive pregnant women
2.4g per day Can be divided into 3-4 doses
68
Labetalol cautionary and advisory labels
Warning: dont stop taking unless your doctor tells you to Take with food or just after a meal
69
Target BP for under 80s to start an antihypertensive
140/90mmHg or more
70
Target BP for over 80s
< 150/90mmHg
71
Pregnancy target BP
< 140/90mmHg
72
Renal disease patients target BP
< 140/90mmHg
73
Target BP for T1DM with no features of metabolic syndrome or albuminuria
< 135/85mmHg
74
Target BP with T1DM with albuminuria or features of metabolic syndrome
< 130/80mmHg
75
Avoid Alpha blockers in what condition?
History of syncope (in BPH patients) or postural hypotension
76
SE of alpha blocker - doxasozin
Orthastatic hypotension

Cardiovascular (9 decks)

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