HYPERTENSION Flashcards
When is BP treatment initiated in the general adult population
140/90 or higher
When is BP treatment initiated in people over 60 years of age
150/90 or higher
Risk factors for primary hypertension
Age
Family history
Obesity
Sedentary lifestyle
When should BP treatment be initiated for patients with CKD or diabetes
140/90 or higher
Cardiovascular risk factors
Age (men ≥ 55 years; women ≥ 65)
Family history of premature cardiovascular disease (men aged < 55 years;
women aged < 65)
Dyslipidaemia
Obesity (BMI ≥ 30 kg/m2)
Diabetes mellitus
Smoking
Pulse pressure (in the elderly) ≥ 60mmHg
Microalbuminuria or proteinuria
Left ventricular hypertrophy
Left bundle branch block
Ischaemic heart disease
Previous stroke or TIA
Periperal arterial disease
Heart failure
Coronary artery disease
Chronic kidney disease
Advanced retinopathy:
Signs of advanced retinopathy
haemorrhages or exudates, papilloedema
Renal causes of secondary hypertension in adults
CKD
Polycystic kidney disease
Endocrine causes of hypertension in CKD
Phaeochromocytoma
Cushing’s syndrome
Conn’s disease
Hypothyroidism
Hyperthyroidism
Acromegaly
Investigations in hypertension
FBC
Chest X-ray
ECG
Urinalysis
BUE/Cr
Serum lipids
Blood glucose
Serum uric acid
Renal and adrenal ultrasound
Echocardiogram
Treatment objectives for hypertension in adults
To reduce blood pressure levels to recommended targets:
To manage co-morbid conditions
To prevent cardiovascular, cerebrovascular and renal complications
To promote therapeutic lifestyle changes
To identify and manage secondary hypertension appropriately
Recommended BP targets in adults
< 140/90 mmHg for age below 60 years, diabetes, CKD
< 150/90 mmHg for age above 60 years
Non-pharmacological interventions in hypertension
Reduce salt intake
Reduce animal fat intake
Ensure regular fruit and vegetable intake
Weight reduction in obese and overweight individuals
Regular exercise e.g. brisk walking for 30 minutes 3 times a week
Reduction in alcohol consumption
Avoid or quit smoking
First line drugs in hypertension
Thiazide Diuretics
Calcium Channel Blockers
Angiotensin Converting Enzyme Inhibitors
Angiotensin Receptor Blockers
Beta-blockers
Preferrable antihypertensive drugs in blacks
thiazide diuretics or calcium channel blockers, either as monotherapy or in some combination therapy
According to STG angiotensin converting enzyme Inhibitors are not recommended as first-line drugs for
uncomplicated hypertension in black patients. T/F
True
When should dual therapy be started
Dual therapy should be started earlier when the blood pressure exceeds
180/110 mmHg.
Preferred antihypertensives in left ventricular hypertrophy
ACEi/ARB
CCB, preferably amlodipine
Preferred antihypertensives in renal dysfunction
ACE-I or ARB; Caution- if eGFR <15min/ml without renal
replacement therapy
Preferred antihypertensive medications in microalbuminuria
ACEi or ARB
Preferred antihypertensive medications in previous stroke
Any of the first-line drugs, especially ACE-I
Preferred antihypertensive medications in coronary artery disease
ACE-I or ARB
Beta-blocker
CCB
Preferred antihypertensive medications in heart failure
ACE-I or ARB
Cardio-selective B-Blockers- bisoprolol, metoprolol, carvedilol
Loop diuretics
Spironolactone in advanced heart failure
Preferred antihypertensive medications in PAD
CCB
ACEi/ARB
Preferred antihypertensive medications in diabetics
ACEi/ARB
Preferred antihypertensive medications in atrial fibrillation
ARB/ACEi
Beta blockers
Contraindications to thiazides
Gout
Contraindications to beta blockers
Asthma
2nd and 3rd Degree AV block
Contraindications to CCB
Heart failure
Contraindications to ACEi and ARB
Bilateral renal artery stenosis
Hyperkalemia
Dose of bendroflumathiazide in hypertension
2.5mg daily
Dose of hydrochlorothiazide in hypertension
12.5 to 25mg daily
Dose of amlodipine in hypertension
5 to 10mg daily
Dose of nifedipine retard in hypertension
10 to 40mg 12 hourly
Dose of lisinopril in hypertension
10 to 40mg daily
Dose of ramipril in hypertension
2.5 to 10mg daily
Dose of losartan in hypertension
25 to 100mg daily
Dose of candesartan in hypertension
4 to 32mg daily
Dose of valsartan in hypertension
80 to 160mg daily
Dose of atenolol in hypertension
50 to 100mg daily
Dose of bisoprolol in hypertension
5 to 20mg daily
Dose of metoprolol in hypertension
50 to 200mg 12 hourly
Dose of carvedilol in hypertension
12.5 to 50mg daily
Dose of labetalol in hypertension
100 to 400mg daily
Second line agents in hypertension
Centrally acting agents - methyldopa
Vasodilators- hydralazine
Alpha blockers - prazosin
Aldosterone antagonists- spironolactone
Dose of methyldopa in hypertension
250 to 1g 8 to 12 hourly
Dose of hydralazine in hypertension
25 to 50mg daily
Dose of prazosin in hypertension
0.5 mg 8-12 hourly and increasing gradually to a max. dose of 20 mg
Dose of spironolactone in hypertension
Spironolactone, oral, 25-50 mg daily
Referral criteria for hypertension
- Those not achieving the target blood pressure (BP) level after several months of treatment
- Those on three or more anti-hypertensive drugs, yet have poor BP control
- Those with worsening of BP over a few weeks or months
- Those with plasma creatinine levels above the upper limit of normal
- Those with diabetes mellitus
- Those with multiple risk factors (diabetes, dyslipidaemia, obesity, family history of heart disease)
- Those not on diuretics but have persistently low potassium on repeated blood tests
- All children, young adults and pregnant women with elevated BP
