Hypertension Flashcards
What is the MOA of spironolactone?
Potassium-sparing diuretic. Aldosterone antagonist —> sodium/water excretion and potassium reabsorption. Increases the risk of hyperkalaemia.
Other than potassium-sparing diuretics, which other drug increases the risk of hyperkalaemia?
ACEi
Thiazide diuretics increase the risk of…
Hypokalaemia
Why is it important to monitor U&Es regularly when using ACEi and all diuretics?
They can cause electrolyte disturbances.
Define malignant (accelerated hypertension)
A BP >180/120 with signs of papilloedema and/or retinal haemorrhage. Also signs of end organ damage e.g. AKI
Why does chronic renal disease cause hypertension?
Increased sodium and water retention, increased renin release and raised BP in attempt to restore GFR.
What is essential (primary) hypertension?
Hypertension with no identifiable cause. 95% of cases.
What are the causes of secondary hypertension?
Renal disease. Consider renal artery stenosis if BP is very high/treatment resistant.
Obesity.
Pregnancy/pre-eclampsia.
Endocrine e.g. hyperaldosteronism, phaeochromocytoma.
What is the most common cause of secondary hypertension?
Renal disease
What are the complications of hypertension?
IHD, stroke, CKD/hypertensive nephropathy, hypertensive retinopathy, HF, AAA.
Why should patients with clinic BP >140/90 have ambulatory BP or home BP to confirm diagnosis?
Due to white coat syndrome giving higher readings.
What are the 3 stages of hypertension?
Stage 1: clinic >=140/90, ABPM/HBPM >=135/85.
Stage 2: clinic >=160/100, ABPM/MBPM >=150/95.
Stage 3 >=180 systolic or >=120 diastolic.
All patients with a new diagnosis of hypertension should have which investigations done to assess for end organ damage?
Urine ACR for proteinuria and dipstick for haematuria.
Bloods: HbA1c, U&Es, lipid profile.
Fundus examination.
ECG.
List the anti-hypertensive medications
ACEi (ramipril).
Beta blockers (bisoprolol).
Calcium channel blockers (amlodipine).
Diuretics, thiazide-like (indapamide).
Angiotensin receptor blockers (candesartan).
When should ARBs be used instead of ACEi?
If they’re not tolerated (e.g. dry cough) or patient is of black/Caribbean descent.
Can ARBs and ACEi be used in combination?
No!!
Describe the management principles for hypertension
Lifestyle advice: healthy diet, stop smoking, reduce alcohol/caffeine/salt intake, regular exercise, weight loss.
Consider anti-platelets or statins.
Antihypertensive medications.
What is the indication for antihypertensives?
Aged <80 years with stage 1 hypertension and either: end organ damage, CVD, renal disease, diabetes or QRISK >=10%.
Stage 2/3 hypertension at any age.
What is the first line medication for a patient <55 years with hypertension?
ACEi
What is the first line medication for patients >= 55 or of black/Caribbean descent with hypertension?
Calcium channel blocker.
Describe the step-wise management of hypertension
Step 1: <55 use A. >=55 or black use C.
Step 2: A+C
Step 3: A+C+D
Step 4: A+C+D+additional. K+ <=4.5 mmol/L use spironolactone. K+ >4.5 mmol/L use alpha blocker or beta blocker.
What are the treatment targets for hypertension?
<80 years —> <140/90
>=80 years —> <150/90
What is the maximum dose of amlodipine?
10mg daily
What is the first line medication for a diabetic with hypertension?
ACEi/ARB
