Hypertension Flashcards
According to CG127 what are the diuretics of choice?
Indapamide or Chlortalidone
Patients who are well controlled on which drug can be allowed to remain taking it?
Bendroflumethiazide.
Smoking has what effect on blood pressure?
Temporarily increases it at time of smoking a cigarette but has no long term impact. Recommended to stop as it has other cardio risks.
What are the modifiable risk factors for hypertension?
BMI
Lipid levels
Smoking levels
Blood pressure
What is the HOME blood pressure target for those under 80 years of age?
Below 135/85mmHg
What is the HOME blood pressure target for those over 80 years of age?
Below 145/85mmHg
What is the clinic BP target for those aged under 80?
Below 140/90mmHg
What is the clinic BP target for those aged over 80?
Below 150/90mmHg
Antihypertensive treatment should be offered to people under 80 with stage 1 hypertension AND what? [5]
Target organ damage. Established cardiovascular disease. Renal disease. Diabetes. A 10-year cardiovascualr risk of higher than 20%
Why would people under 40 years of age with stage 1 hypertension be referred to specialists?
This is because 10-year cardiovascular risk assessments can underestimate the lifetime risk of cardiovascular events in these people.
What is the definition of stage 1 hypertension?
Clinic >140/90mmHg.
At home >135/85 mmHg
What is the definition of stage 2 hypertension?
Clinic >160/100mmHg
At home >150/95mmHg
What is the definition of SEVERE hypertension?
Clinic systolic blood pressure >180 or diastolic >110mmHg.
If the systolic blood pressure of a person falls by 20mmHg or more when they are standing what must be done? [3]
Review medication.
Measure subsequent BP with person standing.
Consider referral if systoms of postural hypotension persist.
What should be done if a person has a clinic BP of 140/90mmHg or higher? [2]
- ABPM to confirm presence of hypertension. (unless severe, in which case: start treatment)
- Investigate for any target organ damage and CVD risk.
What treatment should someone under 55 with hypertension be offered?
ACEI or low cost ARB.
If ACEI not tolerated use ARB.
Can ACEI and ARB be used in conjunction to treat hypertension?
No
What should someone of afrocarribean origin be offered as treatment for hypertension?
CCB or thiazide-like diuretic (chortalidone or indapamide)
If BP is not controlled by step 1 treatment what is step 2?
CCB +ACEI or ARB
If BP is not controlled by step 1 treatment what is step 2 if CCB are not tolerated?
Thiazide-like diuretic such as chortalidone or indapamide and ACEI or ARB.
CCB or thiazide-like diuretic is the treatment for
Hypertension in those over 55 or black.
If BP is not controlled by step 1 treatment what is step 2 for those of afro-carribean origin?
CCB + ARB in preference to ACEI.
Why would beta blockers be used as initial therapy for hypertension? [4]
Younger people:
Intolerance to ACEI and ARB.
Women of child bearing potential.
People with evidence of increased sympathetic drive.
If therapy is initiated with a beta-blocker and a second drug is required what class should be used and why?
CCB instead of thiazide-like diuretic to reduce chance of developing diabetes.
If BP is still not controlled after step 1 and step 2 treatment options what must occur?
Medication review.
If BP is still not controlled after step 1 and step 2 treatment options what can be used as treatment?
IF three drugs needed:
ACEI or ARB + CCB + thiazide-like diuretic.
What is resistant hypertension?
BP >140/90mmHg after treatment with optimal doses of ACEI or ARB + CCB + thiazide-like diuretic.
How is resistant hypertension treated?
Low-dose spironolactone if the potassium level is 4.5 or lower.
Higher dose thiazide-like diuretic if the potassium is higher than 4.5.
What new monitoring must occur during treatment of resistant hypertension?
When using further diuretic therapy for resistant hypertension at step 4, monitor blood sodium and potassium and renal function within 1 month and repeat as required thereafter.
What drug class is used to treat resistant hypertension in those people who cannot tolerate further diuretic therapy?
Alpha or beta blocker.
When would low-dose spironolactone be used to treat resistant hypertension?
If K+ is 4.5 or lower.
When would high-dose thiazide-like diuretic be used to treat resistant hypertension?
If K+ is >4.5
An appropriate dose of an appropriate drug for initial treatment of stage 2 hypertension is:
5mg Amlodipine or other CCB
What is the target BP for someone diagnosed with stage 2 hypertension?
140/90 in clinic,
135/85 at home
What counselling is needed for CCB?
Swollen ankles means need to switch to alternative drug class.
When would a review of someone newly diagnosed with stage 2 hypertension and prescribed 5mg Amlodipine need to be carried out?
Within a month, check BP and occurrence of side effects.
What is the treatment for stage 2 hypertension in T2 diabetic?
ACEI or ARB, Ramipril etc.
ACEI cause hyponatremia
true
ACEI cause hyperkalemia
True
ACEI cause hypernatremia
false
ACEI cause hypokalemia
false
ACEI cause what electrolyte imbalances?
low sodium
high potassium
How do ACEI cause hyperkalemia?
Suppression of angiotensin II leads to a decrease in aldosterone levels. Since aldosterone is responsible for increasing the excretion of potassium, ACE inhibitors can cause retention of potassium
Why is the second treatment step for afrocarribean a CCB + ARB, in preference to an ACEI?
They have lower renin levels.
