Hypertension Flashcards
What is hypertension
High blood pressure
What is hypotension
Low blood pressure
If in a consultation a patient presents high blood pressure, what do you do next
Take measurements on both arms if the difference if more than 15 of the recommended.
Take another one then with the highest arm take a 3rd reading
If the clinical blood pressure is between 140/90 - 180/120 what should be carried out
Ambulatory ( close monitoring for 24hours) blood pressure monitoring should be carried
What BP is considered as hypertension
- 140/90 or higher (150/90) for adults aged over 80
- a day time ambulatory blood pressure of 135/85 or higher
What is the ranges of stage 1 hypertension
140/90 - 159/99 and subsequent ABPM of 135/85 - 149/94
What is stage 2 hypertension
160/100 - 180/120 with an ABPM of 150/95 and higher
What is stage 3 hypertension
When the BP is 180/120 and higher
What is accelerated hypertension
An accelerated hypertension in which the blood pressure reaches 180/120 and above and also the level this high is associated with progressive organ damage.
What is the name of the hypertension that has no identifiable cause but gradually gets worse over the years
Primary/ Essential hypertension
Is hypertension passed on
No, thus having someone with hypertension in your family doesn’t mean you’ll also have it
What is secondary hypertension
Hypertension that occurs as a result of other health conditions
What is amlodipine
Calcium channel blocker 2
How does amlodipine work
It acts on the myocardial muscles, myocardial conducting system and the vascular smooth muscle and it worlks by inhibiting Ca2+ influx
What is the bioavailability of amlodipine via the oral route
Roughly 60%
What is the half life of amlodipine
30-50 hours
What is steady-state plasma concentrations
The concentration in which the drug concentration consistently stays., the equilibrium in which drug concentration consistency stays.
What is angiotensin
A hormone that regulates your blood pressure by narrowing blood vessels
What are Angiotensin converting enzymes
These are enzymes that converts inactive ang I to ang II and degrades active bradykin
What are ace inhibitors
These are drugs that inhibit ACEnzymes that are used to lower high blood pressure by relaxing veins and arteries
What is the mechanism of action for lisinopril
It inhibits the angiotensin converting enzyme in the reninangiotensin system.
What is the oral bioavailability of lisinopril
25%
How long does it take for the peak plasma concentration to be reached
4-8 hours
What is the half life of lisinopril
12 hours
Is lisinopril water soluble and why is that important
Yes and so is not metabolised and so is excreted unchanged
What are ARBs
Angiotensin receptive blockers. These are selective competitive Blockers of the AT1 (angiotensin II type 1) receptor
What are diuretics
A drug that increases urination by reducing fluid build up/storage
What are thiazides?
These are a types of diuretics that are used to treat high blood pressure and heart failure
How do the thiazide diuretics work?
They inhibit Na+ and cl- reabsorption by blocking the na+, c- symporter.
However should be taken at lower doses to have a more prominent vasodilations effect than a diuretic effect
Three examples of ACE inhibitors
- Lisinopril
- ramipril
- enalapril
What different types of drugs can be administered to treat hypertension
- CCBs ( calcium channel blockers)
- ACE inhibitors ( angiotensin converting enzyme inhibitors, stops the production of angiotensin)
- A2RBs (angiotensin II receptor blocker)
- Thiazide like diuretics
What is the first step in the treatment of hypertension under 55 and over 55
Under 55
- ACE inhibitors or A2RBs
Over 55 and black
- CCBs
What happens in step 2 treatment of hypertension
If step 1 is unsuccessful in treating hypertension:
- Offer a CCB in combination with an ACE inhibitor/ A2RB, if CCB not suitable then offer a thiazide like diuretic
- in black people an A2RB should be offered in preference to an ACE inhibitor to have alongside the CCB
What happens in step 3 hypertension
- ensure that all the dosages in step 2 are optimal before combing all three meds: A2RB, CCB and ACE inhibitor
What is resistant hypertension
When a patient is under stage 3 treatments however their BP is still above 140/90.
What happens in stage 4 hypertension treatment
- additional diuretics
- higher dosage of diuretics.
- using alpha or beta blockers