Hypertension Flashcards
What is hypertension
condition where bp is elevated to an extent where clinical benefit is obtained by lowering it
Textbook bp
120/80
Top is systolic and bottom is diastolic
Consequences of hypertension
• Myocardial infarction (MI)
• Cerebral vascular accident (CVA)
(2 biggest)
• Heart failure
• Renal (kidney) disease
• Peripheral vascular disease
• Vascular dementia
Mercury increases
For every 5 mm increase of mercury in diastolic it increases risk of stroke by 35-40%
High risk patients for complications
• Evidence of cardiovascular disease
• Elderly
• Diabetes
• Renal failure
• Lifestyle factors (smoke, diet, stress etc)
How common is hypertension
• UK adult population: 31% men +
26% women
• 65% 65-74yrs
• Ethnicity: Black African + Black
Caribbeans higher incidence
• Still underdiagnosed and
undertreated
• Government target
2 types of hypertension
• 90-95% Primary/Essential
- cause unknown
• 5-10% Secondary
- underlying cause renal (80%) and endocrine disease, pregnancy and drugs
Risk factors of primary
– age
– Gender
– Socio-economic status
– Obesity
– Excess alcohol
– Salt intake
– Ethnicity
– Family history
– Lack of exercise
– Diet (fats)
– Stress
– Smoking
– Other diseases eg DM, renal failure
Drug causes of 2ndary
Rugs that increase BP
• Combined Oral Contraceptives
• NSAIDs e.g. ibuprofen
• Steroids e.g. prednisolone
• Sympathomimetic amines
e.g.pseudoephedrine (cold remedies)
Hypertension clinical presentation
• Asymptomatic
• Headache - unclear if cause or incidental
• Detected at population screening or
presentation of patient with
complication eg. Myocardial infarction,
renal failure etc
Malignant hypertension
• Uncommon
• increase bp (>180/120)
• Confusion, headache, visual loss, coma
• Evidence of small vessel damage:
– Eyes
– Kidneys
– Brain
• Medical emergency
• Rapid control of bp over 12-24 hrs
• Often fatal
• 1 year survival <20%
• Long-term morbidity
• Careful follow-up
Arteries in manual bp measurements
Palpitation of radial artery
Auscultation of brachial artery
Bp can be affected by:
– Fear & anxiety ( including ”white-coat” HT)
– Physical activity
– Caffeine
– Alcohol
– Tobacco
– Temperature
– Full bladder
– Obesity (correct cuff size)
Drug groups to treat hypertension
• Diuretics
• Angiotensin converting enzyme inhibitors
(ACEI’s)
• Angiotensin-II receptor antagonists
(ARBs)
• Calcium channel blockers (CCB)
• Betablockers
• Alpha- blockers
• Centrally acting agents
• Renin inhibitors
Factors which affect which drug to use fast
• (Ability to reduce bp)
• Ability to reduce complications
• Patient characteristics
• Other conditions
• Side-effects
• Adherence
• Cost
What is the 1st factor
Reduce complications
What is the 2nd factor
Patient characteristics
Age - renin drops
ethnicity - people of colour produce less renin
pregnancy - only a few drugs are safe
allergies
When to combine drugs
When target BP isnt reached with monotherapy
75% of people with HT cannot be controlled on one drug alone
How to combine drugs
Combine drugs with different pharmacology/mechanisms of actions or act on different pathways
Avoid combining drugs with same side effects
1st line drugs and their groups
CCB
ACEIs
Diuretics
Aldosterone antagonists
Angiotensin II receptor blockers - ARBs
Beta-blockers
Alpha blockers
Renin inhibitors
Centrally acting agents
CCB
(amodipine, diltiazem) - 1st line for >55years and or black African Caribbean for any age
ACEIs
ACEIs (ramipril, lisinopril) - 1st line for >55yeras and all diabetics
Diuretics
indapamide
Used in combination with other antihypertensives
Can cause low K levels
Not for patients in renal failure
Aldosterone antagonists
Spironolactone
Can cause high K levels
Used for heart failure
