Hypertension Flashcards
Lowering raised Blood pressure will reduce the risk of…
reduces the risk of stroke and coronary events,HF and renal failure
Possible causes of hypertension and what should patients be counselled on?
eg, renal and endocrine),contributory factors,risk factors and presence of complications should be established
- Patients should be given advice about lifestyle changes as they play key role in precipitating high blood pressure
○ Smoking cessation
○ Weight reduction
○ Reduce excessive alcohol and caffeine
○ Reduce dietary salt
○ Reduce total unsaturated fats
○ Increase exercise
○ Increase fruit and veg
THRESHOLD TARGETS:
For anyone under 80- Target clinical
And target ABPM??
What to do with pts over 140/90
- Target for patients under 80=80 140/90(clinic) or 135/85(Ambulatory or home)
- Patients with 140/90 mmhg blood pressure or higher should be offered measurement in ambulatory position or home BP reading to confirm diagnosis and stage of hypertension
Stage 1:
- BP 140/90 or higher and ambulatory/home average 135/85 or higher
- Treat Patients under 80 and target organ damage - LV hypertrophy,CKD,retinopathy,diabetes, CV disease
Give lifestyle changes for patients under 40 with no target of organ damage
- Treat Patients under 80 and target organ damage - LV hypertrophy,CKD,retinopathy,diabetes, CV disease
Stage 2:
- Clinal blood pressure 160/100
- ABPM 150/95 or Higher
- Treat all patients with stage 2 hypertension regardless of age
Stage 3:
- Clinical BP 180/110 or higher
- Treat promptly - hypertensive crisis
TREATMENT PATHWAY - Patients UNDER 55
1) ACE OR ARB
2) ACE OR ARB + CCB or THIAZIDE LIKE DIURETIC
3) ACE OR ARB + CCB+ THIAZIDE LIKE DIURETIC
BETA BLOCKER IS ABSOLUTE LAST LINE - not usually offered
TREATMENT PATHWAY Over 55 and patient of any age by of Afro Caribbean dissent:
1) Calcium channel blocker or thiazide like diuretic
2) Calcium Channel blocker+Thiazide like diuretic
3) ACEi or ARB in combo with CCB and thiazide like diuretic
4) Resistant hypertension
Hypertension with Diabetes - HYPERTENSION = NEPHROPATHY
Ace and arbs delay …..
- Targets of 140/80 or below 130/80 if kidney,eye, cerebrovascular disease present
- Antihypertensive treatment prevents macro vascular and micro vascular nephropathy
- ACEi and ARB inhibitors can delay the progression of microalbuminuria to neuropathy
ARB IS ALWAY FIRST LINE IN DIABETES
Hypertension in renal disease TARGET IS….. and if proteinuria exceedssss…..
- Targets are 140/90 or 130/80 in CKD,diabetes or if proteinuria exceeds 1g in 24 hrs
The Ace Inhibitors - CHHARed
Ramipril, enalapril, lisinopril and perindopril
Cough- give ARB
Hyperkalaemia
Hepatic failure
Angiodema
Renal Impairment
Dizziness and headaches
Angiotensin 11 receptor blockers: ARBBBBS
Candsartan, ibesartan, losartan
Same side effect and interactions as ACEI aPRT FROM COUGH AND ANGIODEMA
Interactions: ACE-I
Causes hyperkalamia so why give drugs that also cause hyperkalaemia?
- Increased renal failure risk- ARB,K-SPARING DIURETIC,NSAIDs
- Increase Hyperkalaemia: heparins, ARBs,nSAIDS,Ksparing diuretics, Beta Blockers
- Increase risk of volume depletion - diuretics
- Increase plasma lithium levels (ARBS too)
Beta bLOCKERS
Atenolol,biosoprolol,carvedilol,labetalol,propranolol,sotalol timolol
BB SE and what does it interact with?
Side effects:
- Bradycardia or heart failure (no amiodarone or digoxin)
- Blunt the effects of hypoglycaemia
- Can cause hyperglycaemia
- Bronchospasm - contraindicated in asthmatic patients
Interact- Digoxin or other hypotensive drugs
Calcium channel blockers- dihydropyridine and rl
Rate limiting - verapamil and diltiazem
Dihdropyridine- Amlodipine,felodipine,lacidipine,lercanidipine,nifedipine
Side effects - Diziness,gingival hyperplasia - enlarged gums,vasodilators effects - flushing =, headaches, ankle swelling
Complete atrioventricular block
