HYPERTENSION Flashcards
List some complications of hypertension… (4)
- Stroke
- MI
- Heart Failure
- Renal Failure
List some non-pharmacological ways to help reduce blood pressure (6)
- Reduce salt intake
- Reduce alcohol intake
- Reduce weight
- Increase fruit and veg intake
- Increase exercise
- Reduce smoking
What is the first line treatment for hypertension in young, white patients?
ACE inhibitors
What is the first line treatment for over 55 or black patients?
CCB’s
What is the upper limit of normal blood pressure for most patients?
140/90 mmHg
What is ‘white coat’ hypertension?
Excessive and unrepresentative blood pressure rises when attending doctor’s surgery
Diabetics should have a target BP of
130/80mmHg
ACE inhibitors can lead to ____ retention
Potassium
What is a common side effect of ACE inhibitors?
Dry cough due to reduced breakdown of bradykinin
What is the next therapy often considered if a patient cannot tolerate ACE inhibitors?
ARBs (angiotensin receptor blockers)
Verapamil and diltiazem are ____ calcium channel blockers and should not be used in the control of blood pressure
Rate limiting
Two side effects of CCBs include…
Ankle swelling and flushing
What antihypertensive is recommended for use in pregnancy?
Methyldopa
When should atorvastatin 20mg be suggested for primary prevention of CVD?
If QRISK2 score is 10% or greater
Are diuretics needed in gravitational swelling of ankles?
No - compression stockings, keep moving, raise feet when not standing
Statin should be prescribed for those with QRISK score of over…
10% or higher
Verapamil is a…
RATE LIMITING CCB
Lorsartan is…
an ARB (angiotensin 2 receptor blocker)
What is classed as Stage 2 hypertension?
Clinic 160/100mmHg or higher
What is classed as Severe hypertension?
Clinic systolic BP over 180mmHg or clinic diastolic BP 110mmHg or higher
Offer antihypertensive treatment to those aged under 80 with stage 1 hypertension if… (5)
- Target organ damage
- Established CV disease
- Renal disease
- Diabetes
- 10 year CV risk 20% or higher
What should be offered if cannot tolerate CCB?
Thiazide like diuretic (chlortalidone or indapamide)
Should bendroflumethiazide be initiated/used?
NOT initiated - not in guidelines. This is a THIAZIDE diuretic not a thiazide LIKE diuretic
BUT keep on if stable on it
What is step 2 treatment in white?
Add CCB to the ACE or ARB
For black or afro caribbean step 2 add ARB to CCB in preference to a…
ACE inhibitor
What is a side effect of statins that we should be aware of?
Muscle pain - myopathy
Statins cannot be taken with what juice?
Grapefruit
What is the first line then second line treatment of angina?
GTN spray then Beta blocker or CCB
What should be used in angina to provide immediate relief and short term prevention?
GTN spray
How should GTN spray be used?
- Before any planned exercise or exertion
- Side effect = flushing, headache and light headedness
- Sit down or find something to hold if light headed
- Repeat dose after 5 mins if pain not gone
When should ambulance be called in relation to angina pain and GTN spray?
- Call ambulance if pain not gone 5 mins after taking second dose
Women should drink no more than __ to __ units per day
2 to 3 units a day
Men should drink no more than __ to __ units per day
3 to 4 units a day
What is a side effect of Verapamil?
Constipation
If a Q-RISK score is over 10% then what should be started?
Atorvastatin 20mg daily
How do sulfonylureas (tolbutamide, gliclazide, glipizide) work and when are they taken?
- Stimulate insulin release by beta cells of pancreas
- Taken with meals to prevent hypos
How do biguanides (Metformin) work?
- Decrease gluconeogenesis and increases peripheral utilisation of glucose
Thiazolidinediones work by WHAT?
- Enhancing tissue sensitivity to insulin
Name a SGLT2 inhibitor and state how it works…
1) Canagliflozin, Dapagliflozin
2) SGLT2 receptor in kidney is responsible for glucose absorption, inhibiting this receptor means less glucose abs so you excrete it in urine
How do DPP-4 inhibitors (Gliptins) work?
- Prevent breakdown of endogenous GLP-1
- GLP-1 = decrease appetite, inc insulin secretion, reduce liver glucose output
