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Cardiovascular System > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the risk factors for Hypertension?

A
  • Age
  • Ethnicity
  • Dietary salt
  • Exercise
  • Alcohol
  • Caffeine
  • Smoking
  • Obesity
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2
Q

What are the secondary causes for hypertension?

A
  • Renal Disease
  • Endocrine Disease
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3
Q

Heart blood pressure can cause target organ damage, to which organs?

A
  • Heart
  • Brain
  • Kidneys
  • Eyes
  • Blood vessels
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4
Q

What are the hypertension thresholds?

A

Stage 1 hypertension:
Clinical - 140/90 – 160/100
Ambulatory - 135/85

Stage 2 hypertension:
Clinical - 160/100 – 180/120
Ambulatory - 150/95

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5
Q

What are the next steps for someone with no hypertension and no target organ damage?

A

Measure clinic BP every 5 years (or more frequently if close to 140/90mmHg)

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6
Q

What are the next steps for someone with no hypertension and target organ damage present?

A

Investigate causes of organ damage

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7
Q

What are the next steps for someone with with hypertension?

A

Lifestyle interventions, drug treatment, investigate if organ damage is present

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8
Q

Which patients with stage 1 hypertension require treatment?

A
  • They are under 60 with an estimated 10-year CVD risk of >10%
  • They are aged 80 or over

OR

They are under the age of 80 with one or more of the following:
* Target organ damage
* Established CVD
* Renal disease
* Diabetes
* 10-year CVD of >10%

If patient is under 40 with no target organ damage, further investigations must be done to determine the cause of the hypertension.

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9
Q

What are the next steps for patients with stage 2 hypertension?

A

Treatment is required, regardless of age

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10
Q

What drugs are used in hypertension?

A
  • Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)
  • Angiotensin-II Receptor Blockers (ARBs)
  • Calcium Channel Blockers (CCBs)
  • Thiazide Diuretics
  • Low-dose Spironolactone
  • Alpha Blockers
  • Beta Blockers
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11
Q

What are the next steps for patients with severe hypertension?

A

Treat promptly with IV antihypertensive

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12
Q

When must patients with hypertension be referred?

A

If they have severe hypertension with any of the following signs:
* Retinal haemorrhage
* Papilledema (accelerated hypertension)
* Life threatening symptoms (e.g. new onset confusion, chest pain, signs of heart failure)
* Suspected phaeochromocytoma (e.g. postural hypotension, headache, palpitations, abdominal pain, pallor)

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13
Q

What are the treatment steps for patients with Hypertension with type 2 diabetes?

A

Step 1: ACE Inhibitor (or ARB)

Step 2: ACE Inhibitor (or ARB) + Calcium Channel Blocker

Step 3: ACE inhibitor (or ARB) + Calcium Channel Blocker + Thiazide Diuretic

Step 4:
Confirm resistant hypertension, confirm elevated BP with ABPM or HBPM, check for postural
hypertension and discuss adherence. Consider adding:

  • Low-dose spironolactone if blood potassium levels <4.5mmol/L.
  • Alpha blocker if blood potassium levels >4.5mmol/L.

Seek expert advice if BP remains uncontrolled on optimal tolerated doses of 4 drugs

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14
Q

What are the treatment steps for patients less than 55 years of age and NOT of Black African or Afro-Caribbean, with hypertension and without type 2 diabetes?

A

Step 1: ACE Inhibitor (or ARB)

Step 2: ACE Inhibitor (or ARB) + Calcium Channel Blocker

Step 3: ACE inhibitor (or ARB) + Calcium Channel Blocker + Thiazide Diuretic

Step 4:
Confirm resistant hypertension, confirm elevated BP with ABPM or HBPM, check for postural
hypertension and discuss adherence. Consider adding:

  • Low-dose spironolactone if blood potassium levels <4.5mmol/L.
  • Alpha blocker if blood potassium levels >4.5mmol/L.

Seek expert advice if BP remains uncontrolled on optimal tolerated doses of 4 drugs

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15
Q

What are the treatment steps for patients more than 55 years old, with hypertension and without type 2 diabetes?

A

Step 1: Calcium Channel Blocker

Step 2: Calcium Channel Blocker + ACE Inhibitor (or ARB)

Step 3: ACE inhibitor (or ARB) + Calcium Channel Blocker + Thiazide Diuretic

Step 4:
Confirm resistant hypertension, confirm elevated BP with ABPM or HBPM, check for postural
hypertension and discuss adherence. Consider adding:

  • Low-dose spironolactone if blood potassium levels <4.5mmol/L.
  • Alpha blocker if blood potassium levels >4.5mmol/L.

Seek expert advice if BP remains uncontrolled on optimal tolerated doses of 4 drugs

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16
Q

What are the treatment steps for patients of Black African or Afro-Caribbean descent of any age, with hypertension and without type 2 diabetes?

A

Step 1: Calcium Channel Blocker

Step 2: Calcium Channel Blocker + ACE Inhibitor (or ARB)

Step 3: ACE inhibitor (or ARB) + Calcium Channel Blocker + Thiazide Diuretic

Step 4:
Confirm resistant hypertension, confirm elevated BP with ABPM or HBPM, check for postural
hypertension and discuss adherence. Consider adding:

  • Low-dose spironolactone if blood potassium levels <4.5mmol/L.
  • Alpha blocker if blood potassium levels >4.5mmol/L.

Seek expert advice if BP remains uncontrolled on optimal tolerated doses of 4 drugs

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17
Q

What is the treatment plan for hypertension in type 1 diabetes?

A

Step 1: ACE inhibitor
Step 2: Beta blocker
Step 3: Low-dose thiazide Diuretic
Step 4: Calcium channel blocker (only long-acting preparations)

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18
Q

What is the target blood pressure for pregnant women?

A

<135/85mmHg

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19
Q

What is the treatment steps for hypertension in pregnancy?

A

1st Line: Labetalol
2nd Line: Nifedipine (Modified-release)
3rd Line: Methyldopa

20
Q

What are the hypertension targets for various conditions?

A

CKD – <130/80mmHg

Type 1 diabetes with albuminuria or features of metabolic syndrome – <130/80mmHg

Pregnancy – <135/85mmHg

Type 1 diabetes – <135/85mmHg

Same day specialist referral – >180/120mmHg

21
Q

What is the mechanism of action for ACE Inhibitors?

A

Inhibit the conversion of angiotensin-I into angiotensin-II

22
Q

What are examples of ACE inhibitors?

A

Examples: ramipril, lisinopril, captopril, enalapril, perindopril, fosinopril etc

23
Q

What are the side effects of ACE inhibitors?

A

First-dose hypotension, angioedema, persistent dry cough

24
Q

What is the mechanism of action for Angiotensin receptor blockers?

A

Block the binding of angiotensin

25
Q

What are examples of angiotensin receptor blockers?

A

Candesartan, irbesartan, losartan, telmisartan, valsartan etc

26
Q

What are the side effects of angiotensin receptors blockers?

A

Same as ACE inhibitors but less likely to cause persistent dry cough

27
Q

What is mechanism of action for renin inhibitors?

A

Inhibits renin directly. Renin converts angiotensinogen into angiotensin-I

28
Q

What are examples of renin inhibitors?

A

Aliskiren

29
Q

Which drug should not be given with ACE inhibitors?

A

Aliskiren - when used together, they can increase the risk of hyperkalaemia, hypotension, and renal impairment.

30
Q

What is the mechanism of action for calcium channel blockers?

A

Interfere with calcium ions through slow channels or active cell membranes

31
Q

Examples of calcium channel blockers?

A
  • Dihydropyridines – amlodipine, felodipine, lacidipine, lercanidipine etc
  • Non-dihydropyridines – diltiazem, verapamil
32
Q

What important prescribing information must be noted for Diltiazem?

A

Preparations containing more than 60mg diltiazem may not
have the same clinical effect and should therefore be prescribed by brand name

33
Q

What are the side effects of calcium channel blockers?

A

Angioedema, dizziness, flushing, postural hypotension and headaches

34
Q

What are the side effects of CCB?

A

Oedema

35
Q

What are the side effects for Thiazide Diuretics?

A

Hypokalaemia
Hyperuricemia
Hypercalcaemia
Hyponatraemia

36
Q

What are the side effects of Spironolactone?

A

Gynaecomastia
Hyperkalaemia

37
Q

What are the side effects of Alpha blockers?

A

Orthostatic hypotension

38
Q

What are the side effects of beta blockers?

A

Bradycardia

39
Q

Which patients must ACEi and ARBs be avoided in?

A
  • Black African or Afro-Caribbean
  • Severe renal disease
  • Pregnancy/breastfeeding
40
Q

Which patients must Thiazide diuretics be avoided in?

A
  • Diabetes
  • Gout
  • eGFR <30
40
Q

Which patients must CCBs be avoided in?

A
  • Oedema
  • Heart Failure (except amlodipine)
  • Unstable angina
41
Q

Which patients must Spironolactone be avoided in?

A
  • Addison’s disease
  • Hyperkalaemia
42
Q

Which patients must Alpha blockers be avoided in?

A
  • History of syncope in BPH
  • Postural hypotension
43
Q

Which patients must Beta blockers be avoided in?

A
  • Asthma/COPD
  • Unstable heart failure
44
Q
A

Cardiovascular System (9 decks)

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