Hypertension Flashcards
What are the stages of hypertension
One: 140/90
- Lifestyle advice
- Antihypertensive drugs
Two: 160/100
- Antihypertensive for all
Three: >180/110
- Treat promptly
When would you offer medication in stage one hypertension?
80+ and BP 150/90
Under 80 w/:
- Target organ damage (CKD, retinopathy)
- 10 year CVD risk >10% (consider if under 60)
- Diabetic, kidney disease
What is given as first line in hypertension?
<55 / T2DM
ACE inhibitor (ARB if not tolerated - dry cough)
55+ / Black
CCB (Thiazide related diuretic if not tolerated (oedema) / HF)
What is given for black african w/ type 2 diabetes
ARB
What is given for a newly diagnosed patient with hypertension who has a medical history of type 2 diabetes + HF and is already on an ACEi?
Thiazide related diuretic
What is second line in hypertension?
(before adding, increase dose of monotherapy) +
<55 / T2DM
ADD CCB OR TRD
55+ / Black
ADD ACEi (or ARB) OR TRD
What is third line in hypertension?
Offer ALL medication (ACEi/ARB and CCB and thiazide like diuretic)
What is fourth line in hypertension?
Confirm resistent hypertension:
K+ <4.5: low dose
spironolactone
K+ > 4.5: high dose alpha blocker OR beta blocker
What is the treatment in pregnant women?
Target: <135/85
- First line: Labetalol (hepatotoxic, STOP if jaundice occurs)
- Alt: nifedipine MR
- If both unsuitable: methyldopa (stop 2 days after birth)
What is the BP targets in <80?
<140/90
What is the BP targets in >80?
<150/90
What is the BP targets in kidney disease?
<140/90
ACR >70: 130/80
What are the BP targets in type 1 diabetes?
<140/90
- ACR >70: <130/80
- 80: <150/90
What is the MOA of ACEi?
Block ACE enzymes that convert angiotensin I to angiotensin II
Angiotensin II raise BP by constricting blood vessels + stimulates release of aldosterone, increasing plasma volume
How is perindopril taken?
30-60 min before food
What are the indications of ACEi and ARB?
- First line: HPT + HF
- LT management after heart attack
- CVD prevention
- Diabetic nephropathy
- CKD
What are the side effects of ACEi/ARBs?
CAPTOPRIL
- Cough dry (ACEi)
- Angioedema (swollen lips + tongue esp in Black)
- Postural hypotension
- Taste disturbance
- Oral ulcer (ACEi)
- Potassium INC
- Renal impairment (RED blood flow to kidneys, lowers GFR by vasodilating the efferent arterial of the glomerulus)
- Indigestion (ACEi)
- Lower BP (1st dose)
Can you use ACi/ARB in pregnancy?
No - teratogenic
What are the interactions of ACEi/ARBs?
Hypotension:
- Diuretics - volume depletion (urinate more, RED blood plasma volume, blood pressure is regulated by plasma volume)
- Anti-hypertensive
- Dopaminergic drug: levo-dopa, dopamine-receptor antagonist
Hyperkalaemia:
- Spironolactone
- Potassium supplements
- Potassium sparing diuretics
- NSAIDs - also INC AKI
What is the MOA of CCB?
- Interferes w/ Ca2+ influx in vascular smooth muscle and heart
- DEC BP, HR + force of contraction, SA note automaticity + AV node conductivity
What are examples of dyhydropyradine CCB
ACT ON BLOOD VESSELS
- Amlodipine (OD)
- Felodipine (OD)
- Nifedipine (SAME brand for MR when dose >60mg)
- Nimodipine (indication: aneurysmal subrachnoid haemorrhage)
Give examples of rate limiting CCB
DEPRESS THE HEART BY RED HR + FORCE OF CONTRACTION
- Diltiazem (SAME brand for MR when dose >60mg)
- Verapamil (arrhythmias)
What are the indications of CCB?
- First line: Hypertension
- Angina
- Arrhythmias
- HF - amlodipine (MUST avoid other CCB due to RED cardiac output)
What are the side effects of CCB?
- Oedema, flushing, headache - associated w vasodilation
- Tachycardia + palpitations
- Angioedema, gingival hyperplasia (enlargement of gums)
- Constipation (verapamil)
