Hypertension Flashcards
A patient comes into the practice with a BP of 147/94. What should you do next?
Repeat the BP a 2nd and 3rd time and record the lowest measurement
After 3 measurements a patient’s BP is at best 145/90. What do you do?
Arrange either home BPs or Ambulatory BP measuring
A 68 year old diabetic has an average BP of 140/85 after ambulatory BP monitoring. What should you do?
Prescribe a CCB
A 44 year old lady has an average ABPM BP of 155/95. How should you manage this according to NICE?
ACEI plus CCB
What lifestyle advice would you give someone with hypertension?
reduce salt intake; avoid alcohol excess; excerise moderately 3-4 times/week; reduce saturated fat intake and increase fruit and veg; lose weight if centrally overweight
For what reason would you not prescribe both an ACEi and ARB together for HTN?
Risk of hyperkalaemia
If an Afrocaribbean 57 year old man with a BP of 150/95 attended your surgery how would you treat him?
with a CCB (all afrocaribbean HTN patients! as well as all >55)
How would you manage a 50 year old lady with a BP persistently around 150/95 and above?
Treat her with ACEi (or ARB if contraindicated) and refer for investigation for secondary causes and target organ damage
If a 68 year old man in persistently getting BPs of around 160/99 despite treatment with Amlodipine what would you do?
Add an ACEi (or ARB of ACEi contraindicated/not tol.) to the CCB.
If BP is not controlled adequately with both an ACEi and a CCB what would you add?
A thiazide diuretic
How to thiazide diuretics act?
They act at the beginning of the distal convoluted tubule and inhibit the reabsorption of sodium
Before step 3 of HTN management as advised by NICE when would you use thiazide diuretics?
If a patient is intolerant of CCBs, has oedema or is at risk of heart failure
Define resistant HTN.
BP or >140/90 despite use of 3 antihypertensives (given at optimal tolerated doses)
When resistant HTN occurs what should you do?
Add a 4th antihypertensive and / or Refer to specialist
What 4th drug might you add to a resistant HTN patient?
one of: - low dose spironalactone
- increase dose of thiazide diuretic
- alpha-blocker - beta-blocker
What metabolic effects can thiazide diuretics have?
reduced sodium and potassium (hyponatraemia/kalaemia)
deranged lipids, hyperglycaemia, hyperuraemia
In what conditions are ACEi contraindicated?
- Severe AS / MS or LV outflow obstruction
- Bilateral renal artery stenosis
- Pregnancy
- Hx of idiopathic or familial angioedema
Which is the only ACEi indicated in children?
Captopril
Explain very briefly what happens with Calcium ions when smooth muscle contracts and relaxes
Contraction = Ca++ influx
Relaxation = Ca++ efflux (&inhibition of influx)
Action of CCBs is to block calcium influx
What overall effect do dihydropyridine CCBs have?
1) Vascular Smooth Muscle relaxation - dilate coronary and peripheral arteries
What additional effect do Verapamil and Diltiazem have besides VSM relaxation? (non-dihydropyridine CCBs)
Slow heart rate (used in arrhythmias) by targeting conducting cells in heart - due to negatively inotropic nature
What drug group should Verapamil never be prescribed with?
Beta-Blockers as both act to slow HR
Name three indications for diltiazem
- HTN - IHD (esp. asthmatics / COPD)
- arrhythmia management
What are the main side effects of diltiazem and verapamil
flushing; constipation; headaches; ankle swelling
