Hypertension Flashcards
What is the Step 1 treatment for HYPERTENSION WITH TYPE 2 DIABETES
ACEi or ARB
(if not tolerated then beta- blocker)
What is the Step 1 treatment for HYPERTENSION WITHOUT TYPE 2 DIABETES
Age <55 and not of black African or African- Caribbean family origin?
ACEi or ARB
(if not tolerated then beta- blocker)
What is the Step 1 treatment for HYPERTENSION WITHOUT TYPE 2 DIABETES
Age 55 or over
CCB
if high risk of heart failure or CBB not tolerated: give thiazaide like diuretc TLD
What is the Step 1 treatment for HYPERTENSION WITHOUT TYPE 2 DIABETES
Black African or African- Carribean family origin
CCB
if high risk of heart failure or CBB not tolerated: give thiazaide like diuretc TLD
What is the Step 2 treatment for a patient already recieving CCB?
Give ACEi or ARB or thiazide like diuretic
*if patient is African/ Carribean, ARB is preferred in their second line treatment
What is the Step 3 treatment for someone who needs antihypertensive drug
ACEi or ARB
+CCB
+ thiazide like diuretic
(give a low dose spironaloctone as the TLD. However, you can give a higher dose TLD if their K+ levels > 4.5)
If other diuretics are ineffective. ADD ALPHA or BETA- BLOCKER
What is the Step 4 treatment for someone who needs antihypertensive drug
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 ≤4.5mmol/L
- alpha blocker or beta blocker if blood potassium level is >4.5mmol/L
seek expert advice if BP is uncontrolled on optimal tolerated doses of 4 drugs
Why should you avoid TLD and beta- blocker together ESPECIALLY in diabetes or high risk of diabetes?
both drugs cause hypoglycaemia
CCB
calcium channel blocker
TLD
thiazide like diuretic
ACEi
Ace inhibitor
ARB
Angiotensin II receptor blocker
What is normal hypertension
120/ 80 mmHg
What should you do if a patient has blood pressure of 140/90?
When would you treat such a patient?
OFFER LIFESTYLE ADVICE
ONLY TREAT IF UNDER 80 with:
- target organ damage (left ventricular hypertrophy, CKD, retinopathy)#
- CVD or 10 year CVD risk >20%, renal disease, diabetes
What should you do if a patient has a blood pressure of 160/90?
ALL patients with such a blood pressure SHOULD be treated
What should you do if a patient has a blood pressure of >180 as their SYSTOLIC and >110 as their DIASTOLIC?
This is a HYPERTENSIVE CRISES.
It can be either a HYPERTENSIVE EMERGENCY or a HYPERTENSIVE URGENCY
What is hypertensive emergency
HYPERTENSIVE EMERGENCY:
- in a hypertensive emergency, the blood pressure is so high that it is causing immediate and severe damage to one or more critical organs. This is a life-threatening situation that requires rapid medical intervention, typically in a hospital setting, to lower the blood pressure and prevent further organ damage or complications.
-Treatment involves IV medications to lower blood pressure rapidly. Otherwise can have: reduced organ perfusion= blindess, MI, cerebral infarcation and severe renal impairment
What is hypertensive urgency
blood pressure is significantly elevated but does not currently exhibit acute or immediate target organ damage. Unlike a hypertensive emergency, where there is evidence of acute organ damage, hypertensive urgency is characterized by the high blood pressure itself without other acute symptoms or complications.
Treatment: Oral medications to reduce blood pressure slowly over 24- 48 hours.
(gradually and safely lower the blood pressure over a period of hours to days to reduce the risk of complications over the long term)
what is reduced organ perfusion
inadequate perfusion (blood flow) to vital organs
can result in organ damage
hypertensive emergency can cause reduced organ perfusion
(Chronic high blood pressure can cause the arteries and arterioles (smaller blood vessels) to constrict or narrow. When blood vessels narrow, it increases resistance to blood flow, making it harder for blood to move through these vessels. As a result, blood flow to organs and tissues can be compromised, reducing perfusion.)
why can high blood pressure lead to retinopathy?
Extremely high blood pressure can damage the blood vessels in the eyes, leading to retinopathy. Rapid reduction of blood pressure can help prevent or minimize this eye damage and reduce the risk of blindness.
why can severe high blood pressure lead to myocardial infarction (heart attack)
Severe hypertension can place excessive strain on the heart, increasing the risk of a heart attack (myocardial infarction). Lowering blood pressure quickly can reduce this strain and minimize the risk of cardiac events.
why can high blood pressure cause kidney damage?
reduced organ perfusion
Impaired blood flow to the kidneys can lead to kidney dysfunction or failure.
What are clinical blood pressure targets in: UNDER 80 YEARS?
IF they have atherosclerotic CVD* or diabetes with kidney, eye or cerebrovascular disease**
130/80
For EVERYONE ELSE
<140/90
- a condition in which fatty deposits (plaques) build up on the inner walls of arteries.
** a group of medical conditions that affect the blood vessels and blood supply to the brain
What are clinical blood pressure targets in: OVER 80 YEARS?
<150 /90
What are clinical blood pressure targets in: pts with RENAL DISEASE
IF CKD, Diabetes, proteinuria > 1g in 24 hours:
< 130/ 80
(consider ACEi/ ARB if proteinuria present)
FOR EVERYONE ELSE:
<140/90
what are clinical blood pressure targets in: pts with DIABETES?
IF have complications with their diabetes such as: EYE, KIDNEY or CEREBROVASCULAR DISEASE
<130/80
FOR EVERYONE ELSE
<140/80
(THIS IS NOT A TYPO, IT ACTUALLY IS 80 AND NOT 90!)
What are clinical blood pressure targets in: pregnant pts?
CHRONIC HYPERTENSION
<140/90
CHRONIC HYPERTENSION & if target organ damage or have already given birth
<140/90
What drug is widely used as first choice in gestational hypertension?
Labetalol
(this drug is hepatotoxic- remember that
Other drugs include:
methyldopa (stop 2 days after birth)
nifedipine MR (unlicensed)
What is the mechanism of action of angiotensin- converting enzyme inhibitors?
Inhibits the conversion of angiotensin I to angiotensin II
Angiotensin II is a potent vasoconstrictor, meaning it narrows blood vessels, leading to increased blood pressure. It also stimulates the release of aldosterone, which promotes sodium and water retention by the kidneys, further raising blood pressure.
Therefore ACEi inhibiting the conversion of angiotensin I to angiotensin II, ACE inhibitors cause blood vessels to dilate or relax. This dilation reduces peripheral vascular resistance, which is the resistance that the heart must overcome to pump blood through the circulatory system. As a result, blood pressure decreases, and the workload on the heart is reduced.
ACE inhibitors also lead to a decrease in the production of aldosterone, a hormone that acts on the kidneys to increase the reabsorption of sodium and water. By reducing aldosterone levels, ACE inhibitors promote the excretion of sodium and water by the kidneys, which helps lower blood pressure and reduce fluid retention.
Give examples of ACE inhibitors?
Captopril (BD)
ENALAPRIL
Fosinopril
Imidapril
LISINOPRIL
Moexipril
PERINDROPIL (30- 60 minutes before food)
Quinapril
RAMPIRIL
Trandolapril
All ACEi inhibitors should be done once a take except for one of them. What is this and what is its dosing?
CATOPRIL
should be taken BD
When should a patient take their first dose of ACEi
At bedtime
(could be to mitigate side effects, as individuals may sleep through the initial period when side effects are most likely to occur)