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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
Q

Stage 2 hypertension, which ages would be given anti hypertensives

A

Treat all regardless of age

(160/100mmHg)

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26
Q

Stage 3/ severe hypertension treat all by giving

A

IV anti hypertensive

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27
Q

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
A

Refer to the hospital. Carry out investigations for target organ damage asap

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28
Q

A patient has accelerated hypertension and organ damage, hes still awaiting his home/ABPM results. what do you recommend?

A

Start antihypertensive immediately without waiting for results

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29
Q

A patient presents to you with accelerate hypertension but with no target organ damage. What do you recommend?

A

Repeat clinic BP within 7 days

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30
Q

In all patients with DIABETES and HYPERTENSION the first line is

A

ACEI or ARB regardless of family origin or age

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31
Q

Which is preferred in Caribbean origin?

ACEi or ARBS

32
Q

Which Diuretic is preferred in hypertension, bendroflumethiazide or indapamide?

A

Indapamide unless already stable on bendro

33
Q

Why are Antihypertensives beneficial in diabetic patients

A

Reduces risk of macro vascular complications

34
Q

Diabetes macrovascular complications

A

CDV
Increased risk of MI/stroke

35
Q

Diabetes microvascular complications

A

Kidney problems
Retinopathy
Nephropathy

36
Q

Hypertension with T2DM treatment:

A
  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
Q

Hypertension treatment
No diabetes
Under 55 And not of black origin

A
  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
Q

Whats the relationship of renin with age and origin

A

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
Q

Hypertension treatment
Agee 55 or over or of black origin

A
  1. CCB

2.CCB + ACEi/ ARBs/TLD

  1. ACEi/ARB + CCB + TLD
    1. Spironolactone 25mg if K+ <4.5mmol otherwise alpha blocker - doxasozin or BB
40
Q

Before moving onto step 4 anti hypertensives check:

A

Check for postural hypotension
Confirm resistant hypertension at home/ABPM
Discuss adherence

41
Q

Give examples of BB used in 4th line antihypertensive treatment

A

Atenolol
Bisoprolol

42
Q

Can tamsulosin be added in 4th line antihypertensive treatment?

A

No
Its an alpha blocker but used for BPH

43
Q

Which CCB do we use in hypertension

A

Dihydropyridines- amlodipine

44
Q

Why arent rate limiting CCB used in hypertension

A

They influence heart rate

45
Q

Major SE of dihydropyridines

How to respond?

A

Oedema

Stop and give alternative

46
Q

Why is spironolactone mot given if the K+ levels >4.5mmol/l

A

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
Q

How do TLD affect K+ levels

A

Hypokalaemia

48
Q

When taking a combination of antihypertensive you are at risk of

A

Hypotension

49
Q

What time of day should you take diuretics

50
Q

What time of day should you take ACEi

51
Q

When do you take amlodipine- time of day

52
Q

Measure standing and sitting BP if:

A

T2DM
80 or ocer
Symptoms of postural hypotension

53
Q

In T1DM with hypertension which CCBs are used

A

Long acting preparations such as MR nifedipine

54
Q

T1DM and hypertension treatment:

A
  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
Q

Do ACEi protect the kidney

A

Only in diabetic patients otherwise they could damage them

56
Q

can BB be given in AV block

A

Caution in 1st degree AV block

CI in 2nd and 3rd Degree AV block

57
Q

BB contraindicated in the conditions:

A

2nd and 3rd degree AV block

Prinzmetals angina

Marked bradycardia

Unstable HF

58
Q

Whats the target BP in patients with diabetes and CKD or if creatinine ratio >70mg/mmol

A

< 130/80mmHg

59
Q

Target BP in patients with renal disease

A

< 140/90mmHg

60
Q

Can ACEi be used in renal impairment
Why

A

with caution because ACEi cause hyperkalaemia and low CrCl increases the risk of hyperkalaemia

61
Q

How does CrCl affect K+

A

Low CrCl increases hyperkalaemia risk

62
Q

What are the drugs used in hypertension in pregnant patients

A

Labetalol
MR nifedipine (unlicensed)
Methyldopa (unlicensed)

63
Q

Avoid Labetalol in pregnant patients with the conditions _____

A

COPD
asthma
Unstable HF

64
Q

A pregnant patient is on methyldopa to control her hypertension. When would you stop this medication

A

2 days after birth and continue regular hypertension treatment

65
Q

Whats used in severe hypertension in pregnant women

A

IV magnesium sulphate is used in critical care or severe hypertension

66
Q

Whats the Labetalol dose in hypertensive pregnant women

A

100mg BD; dose increased at intervals of 14 days

Usual dose 200mg BD; increased if necessary to Up to 400mg BD

67
Q

Whats the max dose of labetalol use in hypertensive pregnant women

A

2.4g per day

Can be divided into 3-4 doses

68
Q

Labetalol cautionary and advisory labels

A

Warning: dont stop taking unless your doctor tells you to

Take with food or just after a meal

69
Q

Target BP for under 80s to start an antihypertensive

A

140/90mmHg or more

70
Q

Target BP for over 80s

A

< 150/90mmHg

71
Q

Pregnancy target BP

A

< 140/90mmHg

72
Q

Renal disease patients target BP

A

< 140/90mmHg

73
Q

Target BP for T1DM with no features of metabolic syndrome or albuminuria

A

< 135/85mmHg

74
Q

Target BP with T1DM with albuminuria or features of metabolic syndrome

A

< 130/80mmHg

75
Q

Avoid Alpha blockers in what condition?

A

History of syncope (in BPH patients) or postural hypotension

76
Q

SE of alpha blocker - doxasozin

A

Orthastatic hypotension

Cardiovascular (9 decks)

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