Hypertension Flashcards
what is stage 1 of hypertension
- clinic = 140-90 - 159/99
- ambulatory = 135/85 - 149/94
what is stage 2 of hypertension
- clinic = 160/100 - 180/120
- ambulatory = >150/95
what is stage 3 of hypertension
> 180 /120
in stage 1 of hypertension which pt group do you give drug tx to
pt = <80yr with kidney disease, diabetes, CVD or 10% risk of CVD in 10yr
in stage 1 of hypertension which pt group do you give drug tx AND lifestyle advice to
in pt = <60 with <10% risk of CVD in 10yr
in stage 1 of hypertension when do you give drug tx to 80+yr
BP over 150/90
in stage 2 of hypertension who do you give drug tx to?
all pt
what is stage 3 of hypertension known as
hypotensive crisis = medical emergency
tx of hypertension pt < 55yr + pt with TY2D
1) ACEi/ARB
2) ACEi/ARB + CBB or TLD
3) ACEi/ARB + CCB + TLD
4) k+ < 4.5mmol/l = low dose spironolactone
k+ > 4.5mmol/l = a/bblocker
if pt has type 2 diabetes and afro-caribbean what is preferred ACEi or ARB
ARB
tx of hypertension > 55yr and pt = afro-caribbean origin
1) CCB
2) CBB + ACEi/ARB or TLD
3) ACEi/ARB + CCB + TLD
- k+ < 4.5mmol/l = low dose spironolactone
- k+ > 4.5mmol/l = a/bblocker
Examples of ACEi
ramipril
enalapril
lisinopril
perindopril
S/E of ACEi?
CHHARD
-C = cough
-H = hyperkalaemia
-H = hepatic failure
-A = angiodema
-R = renal failure
-D = dizziness + headaches
examples of ARB
Candesartan
irbersartan
losartan
S/E of ARB
HHRD
-H = hyperkalaemia
-H = hepatic failure
-R = renal failure
-D = dizziness + headaches
SAME interactions for ARB
ACEi interactions
- high risk of renal failure = ARBs, K sparing diuretics, NSAIDs
- high hypercalcaemia = heparin, ARBs, NSAIDs, k sparing diuretics, bblockers
- high risk of vol depletion = diuretics
- high plasma lvls of lithium
which bblocker is given in gestational pregn
labetalol
less likely to cause bronchospasms - preferred in ASTHMA
which bblockers are cardio selective?
BArMAN
- bisoprolol
- atenolol
- metoprolol
- acebutolol
- nebivolol
less likely to cross BBB less nightmares
which bblockers are water soluble
CANS
-celiprolol
-atenolol
-nadolol
-sotalol
lowers cause of cold extremities
which bblockers are intrinsic sympathomimetic
PACO
-pindolol
-acebutolol
-celiporolol
-oxprenolol
what are the s/e of bblocker
- bradycardia or HF
- blunt effects of hypoglycaemia
- causes hypercalcemia
- bronchospasm
interactions of bblocker
-digoxin - heart block
- hypotensive drugs
which CCB are dihydropyridine?
amlodipine, felodipine, lacidipine, lercanidipine, nifedipine
which CCB are rate-limiting
diltiazem, verapamil
s/e of CCB
- dizziness
- gingival hyperplasia - enlarged gums
- vasodilatory effects (flushing, headaches, ankle swelling) higher in dihydropyridine
- complete atrioventricular block - higher in RL CCB
what are pregnant pt at risk of in hypetension
- high risk of developing pre-eclampsia in; CKD, diabetes, autoimmune disease, hypotension
-take aspirin from WK12 of pregn till birth
tx of pregnancy hypertension with BP of <140/90
1) labetalol
2) nifedipine or methyldopa
3) aim for target of 135/85
aim for BP target 5 less than clinical for ambulatory
what are the target ranges of hypertension in <80yr?
-clinical = 140/90
-ambulatory = 135/85
aim for BP target 5 less than clinical for ambulatory
what are the target ranges of hypertension in >80yr ?
-clinical = 150/90
-ambulatory = 145/85
what are the target ranges of hypertension in renal disease?
clinical = 140/90
what are the target ranges of hypertension in pregnancy?
clinical = 135/85
what are the target ranges of hypertension in type 1 diabetes?
clinical = 135/85
