Hypertension Flashcards
What is the definition of hypertension?
The blood pressure at which the benefits of treatment outweigh the risks
What BP is Stage 1 hypertension in a clinical setting?
140/90 mmHg
What BP is Stage 2 hypertension in a clinical setting?
160/100 mmHg
What BP is severe hypertension in a clinical setting?
180/110 mmHg
What gender is at a higher risk of getting hypertension?
Maleds
What are 5 medical risk factors for Hypertension?
Diabetes Renal disease Previous MI or stroke Hyperlipidaemia Left ventricular hypertrophy
How is blood pressure affected by age
BP rises with age
What effect does reducing salt intake have on hypertensive individuals?
It lowers blood pressure
What effect do small amounts of alcohol have on BP?
Decreases BP
What effect do large amounts of alcohol have on BP?
Increases BP
What is the most important non-pharmacological measure that can be taken for treating hypertension?
Weight reduction
What is the relationship between birth weight and hypertension?
The lower the birth weight, the higher risk for developing hypertension later in life
What is the racial influence on blood pressure?
Caucasians have lower BP than black population
What is the relationship between black populations and salt intake?
Black people are higher salt retainers
What are the effects of sustained hypertension?
End-organ damage (blood vessels, heart and kidney)
What are 3 organ-related areas of disease that can be a cause for secondary hypertension?
Renal
Endocrine
Vascular
What are 3 types of drugs that can induce hypertension?
NSAIDs
Oral contraceptive
Corticosteroids
What condition in pregnancy can cause hypertension?
Pre-eclampsia
What night time respiratory condition can be a cause for hypertension?
Sleep Apnoea
What are 2 of the main endocrine conditions that can cause hypertension?
Conn’s syndrome
Cushings disease
What blood pressure apparatus must be used to identify hypertension in the clinic?
ABPM (Ambulatory blood pressure monitoring)
What blood pressure apparatus must be used to identify hypertension at home?
HBPM (Home blood pressure monitoring)
What 2 actions should be taken in clinic when hypertension is identified?
Assess end organ damage
Screen for treatable causes
What is the stepped approach?
To use low doses of medication and add on to the current medication as opposed to changing it
What are the 4 main categories of drug treatments for hypertensive patients?
AVE inhibitor
ARB
Calcium channel blocker
Thiazide - type diuretic
When should under 80 Stage 1 hypertensives be offered treatment?
When there is an additional problem/risk factor (i.e. organ damage/diabetes)
What drug should be used as step 1 in over 55s and black people?
CCB
What drug should be used as step 1 in under 55s? (2)
ACE indibitor
ARB
What drug should be used as a step 2 in all occasions?
Thiazide-type diuretic
What is Step 3 treatment of hypertension?
CCB, ACEI and diuretic
What is step 4 treatment if the blood potassium level is 4.5mmol/l or lower?
Further diuretic with low-dose spironolactone
What is step 4 treatment if the blood potassium level is higher than 4.5mmol/l?
High does thazide diuretic treatment
What is the the function of ACE inhibitors?
Competitively inhibits angiotensin converting enzyme (ACE)
What is the function of ACE?
Converts angiotensin I to angiotensin II
What are 2 examples of ACE inhibitors?
Ramipril
Perindopril
What are 2 contraindications of ACEI?
Renal failure
Renal artery stenosis
What are 3 adverse drug effects of ACEI?
Cough
Taste disturbance
Renal impairment
What is the function of ARBs?
Angiotensin II antagonists that competitively block the actions of angiotensin II
What are 2 examples of ARBs
Losartan
Valsartan
What is a medical benefit of ARBs over ACEI?
ARBs don’t produce a cough
What are the 2 types of CCB?
Vasodilator
Rate limiting
What are 2 examples of vasodilator CCBs?
Amlodipine
Felodipine
What are 2 examples of rate limiting CCBs?
Verapamil
Diltiazem
How to CCBs work?
They block L-type calcium channels which reduces cardiac output
In what demographics should vasodilating CCBs be used? (2)
Over 55s
Women of child bearing age
What are the contraindications for CCBs (1) and those specific to rate limiting CCBs? (2)
Acute MI
Heart failure, bradycardia
What are 4 adverse drug reactions reactions of CCBs?
Flushing
Headache
Angle oedema
Indigestion
What are 2 adverse drug reactions specific to rate limiting CCBs?
Bradycardia
Constipation
What are 2 examples of thiazide-type diuretics?
Indapamide
Clortalidone
How do thiazide-type diuretics work?
They block reabsorption of sodium and enhave urinary sodium loss
What are 2 adverse drug reactions of thiazide-type diuretics?
Gout
Impotence
What hypertension drugs should be used during pregnancy? (2)
Thiazide-type diuretics
amlodipine
What is accelerated hypertension?
A resent significant increase in BP that is associated with target organ damage
