Hypertension Flashcards
What is stage 1 hypertension
Clinic BP 140/90mmHg - 159/99mmHg
HBP 135/85mmHg - 149/94mmHg
What is stage 2 hypertension
Clinic BP - 160/100 mmHg or higher but less than 180/120 mmHg
HBP - 150/95 or higher
What is severe hypertension
Clinic systolic BP of 180 mmHg or higher or
Clinic diastolic BP of 120 mmHg or higher
What is given for hypertension in type 2 diabetes
ACE Inhibitor
What is given for hypertension in type 2 diabetes in Black Afro-Carribbean
ARB
What is given for hypertension in under 55 and not Black Afro-Carribbean
ACE Inhibitor
What is given for hypertension in over 55’s
Calcium Channel Blocker
What is given for hypertension in Black Afro-Caribbean of any age
Calcium Channel Blocker
What is the BP target for under 80s
Clinic BP <140/90
HBPM <135/85
What is the BP target for over 80s
Clinic BP <150/90
HBPM <145/85
When can low dose spironolactone be given in hypertension
Step 4: If potassium is <4.5
When can an alpha blocker or a beta blocker be given in hypertension
Step 4: If potassium is >4.5
What is the BP target for under 80s with type 1 diabetes
Clinic BP:
If ACR <70 : <140/90
If ACR >70 : <130/80
What is the BP target for over 80s with type 1 diabetes
Clinic BP: <150/90
What is the BP target for patients with CKD and a ACR <70
Clinic BP below 140/90mmHg
What is the BP target for patients with CKD and a ACR >70
Clinic BP below 130/80mmHg
What is the BP target for pregnant women with chronic hypertension
<150/100mmHg
What is the BP target for pregnancy women with chronic hypertension and if target organ damage/given birth
<140/90mmHg
What is first line for hypertension in pregnancy
Labetalol
What can be given for hypertension in pregnancy if first line is not suitable
Second line: Nifedipine MR
Third line: Methyldopa
When does methyldopa need to be stopped
2 days after birth
What can be given in an emergency setting for severe hypertension or severe pre-eclampsia or if they have or have previously had an eclamptic fit
Magnesium Sulfate
What is first line for hypertension post birth/ breastfeeding in non black afro carribbeans
Enalapril
What is first line for hypertension post birth/ breastfeeding in black afro carribbeans
Nifedipine or Amlodipine
If not controlled with single drug consider a combination. If this combination is not tolerate or ineffective consider either adding labetalol or atenolol to the combination or swapping.
Which ACE Inhibitor needs to be taken 30 to 60 minutes before food
Perindopril
Which ACE Inhibitor is taken twice daily
Captopril
Can ACE Inhibitors be given in pregnancy
NO - AVOID
What are the common adverse reactions / side effects with ACE Inhibitors
Persistent dry cough
Hyperkalaemia
Higher risk in renal impairment and diabetes mellitus
Angioedema
Dizziness and headaches
Hepato-biliary disorders - Cholestatic jaundice, hepatic failure, Stop if LFTs 3x normal or jaundice occurs
Other common adverse effects:
Abdominal discomfort, alopecia, arrhythmias, chest pain/angina, constipation, diarrhoea, drowsiness, dry mouth, dyspepsia, dyspnoea, n&v, rash, myalgia, rhinitis, taste disturbance and vertigo, hypOglycaemia
What are the common interactions with ACE Inhibtors
HYPERKALAEMIA
Aliskeren, ARB, K sparing diuretics / aldosterone antagonists, ciclosporin, heparin, trimethoprim
NEPHROTOXICITY AND REDCUED eGFR
NSAIDs (afferent arteriole constriction)
HYPOTENSION
Diuretics (volume depletion = low BP)
RENAL IMPAIRMENT
Avoid concomitant ACE + ARB (diabetic neuropathy)
DIGOXIN
Concomitant use with captopril can increase plasma concentrations of digoxin
ALLOPURINOL
Possible increased risk of leucopenia and hypersensitivity reactions, especially in people with renal impairment
LITHIUM
Concomitant use can increase plasma levels of lithium. Regular monitoring of serum lithium
