hypertension Flashcards
primary prevention of a disease
preventing a disease form happening
secondary prevention of a disease
preventing the disease from recurring
tertiary prevention of a disease
reducing the complications of a complicated disease
what is hypertension
blood pressure of greater than or equal to 140 and diastolic blood pressure of greater than or equal to 85
hypertension severity
check on nice guidelines
hypertension increases the risk of what diseases ?
heart failure
coronary artery disease
aortic syndrome
stroke
chronic kidney syndrome
peripheral arterial disease
vascular dementia
visual impairment
primary hypertension
hypertension with no single identified cause may be because of genetics and environment
secondary hypertension
hypertension that is as a result of another disease for example renal disease
what are the risk factors for primary hypertension
birthweight
age
genetics eg ethnicity
co -morbidities
latrogenic
lifestyle factors such as obesity , stress , smoking , alcohol, stimulants and lack of exercise
autoregulation of blood pressure
kidney system
Natiuretic peptides
endothelium
SNS
how does sympathetic activation affect hypertension
vasoconstriction - increased MAP through increasing peripheral resistance
reflex tachycardia
increased stroke volume - increased cardiac output
stimulates renin release
what causes the activation of RAAS
Fall in blood pressure , sodium depletion and fall in the circulating volume of blood
how does raas system work
there is release of renin form the juxtaglomerular cells of the kidney - renin converts angiotensinogen produced by the liver to angiotensin 1 which is later converted to angiotensin 2 by ACE enzyme released from the lungs.
what is the effect of angiotensin 2
causes vasoconstriction of major vessels
acts on adrenal gland to release aldosterone hormone which acts on the kidney and help with reabsorption of water .
how is hypertension managed ?
assessing organ damage
what investigations are done to assess organ damage
ECG to test shows hypertrophy
urine test to test on proteinurea there will be proteins in the urine which shows lack of kidney function.
bloods- presence of troponin cardiac muscle failure
echocardiogram - will show hypertrophy
eye test to test on retinal pressure
non pharmacological management of hypertension
lifestyle factors such as diet , exercise
antihypertensive drug monitoring treatment and blood pressure targets
hypertension with or without diabetes
of african heritage ( any age )
of caucasian heritage over 55
of caucasian heritage under 55
hypertension with type 2 diabetes first line drugs
ACE or ARB
hypertension without diabetes for african or caribbean heritage of any age
CCB
hypertension without diabetes for caucasian over 55
CCB
hypertension without diabetes for caucasians and under the age of 55
ACE or ARB
if symptoms persist for an african or a caucasian over 55 without diabetes
add ACE or ARB or thiazide like diuretic
if symptoms persists for someone with diabetes
add CCB or thiazide like diuretic
last stroke for hypertension with or without diabetes
ACE or ARB + CCB + thiazide like diuretic
last step for someone who does not respond to step 3
alpha blocker , or beta blocker i potassium level is greater than 4.5
low dose spironolactone if blood potassium level is less than 4.5
what are ACE drugs
angiotensin conversion inhibitors which inhibit the conversion of angiotensin 1 to 2
they inhibit vasoconstriction and inhibit salt and water retention
example of ACE drugs
ramipril
enalapril
perindopril
side effects of ace inhibitor
dry cough
angioedema
not for pregnant women
caution with ACE inhibitors
renal artery stenosis
CKD
drug interactions
NSAIDS PLUS THE ACE WILL BE A LOAD FOR THE KIDNEY
NO POTASSIUM SILENCE
Angiotensin receptor blockers
Work by blocking angiotensin 2 receptors
what are the side effects of ARB
they have few side effects
examples of ARB
losartan, candesartan, valsartan
calcium channel blockers
inhibit the bondage of L type calcium ion channel receptors
side effects of calcium channel blockers
leg swelling
dry mouth
bradycardia
side effects of calcium channel blockers
dry mouth
leg swelling
bradycardia
drug interactions of CCB
do not prescribe with a non -dihydropyridine with a beta blocker
what are examples of thiazide like diuretics
indapamide
how do thiazide like diuretics function
they have diuretic effect that is loss of water
what are the side effects of thiazide like diuretics
they cause hypokalaemia
mineralocorticoid receptor antagonists
they inhibit the action of aldosterone at the descending collecting tubule and the collecting duct.
and they are potassium sparing
side effects of mineralocorticoid receptor antagonists
hyperkalaemia
gynaecomastia which is caused by spironolactone
alpha adrenoreceptor antagonist
doxazosin which is started at a lower dose and continued at a higher dose in profound hypertension
non cardio -selective beta blocker
propranolol and carvedilol
cardio- selective beta blocker
bisoprolol , atenolol and metoprolol
vasodilator drugs
hydralazine
anti -hypertensive choice for pregnant women
stop ACE and ARB
labetalol (mixed alpha and beta blocker)
methyldopa (centrally acting)
nidefipine (calcium channel blocker)
