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A13THP @ UoN > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define Hypertension

A

A blood pressure which is associated with significant cardiovascular risk

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2
Q

What is the cause of essential (primary) hypertension?

A

Unknown, may be multifactorial

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3
Q

What is the cause of secondary hypertension?

A 
Renal disease
Renovascular disease
Conn's syndrome
Cushing's syndrome
Hyperthyroidism
Phaechromoycytoma
Pregnancy
Drugs
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4
Q

How do ACEIs work?

A

ACE Inhibitors inhibit Angiotensin Converting Enzyme
Prevents AI-AII
AII causes vasoconstriction/converted to aldosterone
Reduced aldosterone = reduced salt/water retention

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5
Q

Give several named examples of ACEIs

A 
Ramipril
Lisinopril
Enalapril
Captopril
Perindopril
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6
Q

What are the main side effects of ACEIs?

A 
Cough (potentiated bradykinin)
Increase K+
Angioedema
Worsening of renal function
Severe first dose hypotension
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7
Q

When should ACEIs be avoided, and why?

A

Renovascular disease

Renin-dependent hypertension, ACEIs lead to renal underperfusion and SEVERE HYPOTENSION

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8
Q

When should ACEIs be given preferentially, and why?

A

In patients with diabetes - Prevention of nephropathy

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9
Q

What should be monitored before/during treatment with ACEIs?

A

Creatinine levels - indicator of renal function

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10
Q

What are ATRAs/ARBs?

A

AT1 receptor antagonists

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11
Q

How do ATRAs/ARBs work?

A

Block the action of AII at AT1 receptors

Similar effect to ACEIs but no cough

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12
Q

What are the two main classes of clinical vasodilators?

A

Calcium Channel Blockers

Alpha-Blockers

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13
Q

How do Calcium Channel Blockers work?

A

Inhibit voltage operated calcium channels on vascular smooth muscle
Vasodilation and reduced BP

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14
Q

Give several named examples of Calcium Channel Blockers

A

Diltiazem
Verapamil
Dihydropyridines (Amlodipine, Nifedipine, Felodipine)

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15
Q

How do dihydropyridines differ from Verapamil?

A

Verapamil exerts most of its effects on the heart

Dihydropyridines exerts most of their effects on arteriole smooth muscle

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16
Q

How do Alpha-Blockers work?

A

Competitive receptor antagonists of a1-adrenoceptors

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17
Q

Why are Alpha-Blockers last choice antihypertensives?

A

Widespread side effects make them poorly tolerated

ie. postural hypotension

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18
Q

How do Thiazides/Thiazide-like diuretics work?

A

Inhibit Na+/Cl- in the DCT

Reduce circulating volume AND cause vasodilatation

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19
Q

Give several named examples of Thiazides/Thiazide-like diuretics

A

Thiazide-like (Chlortalidone, Indapamide)

Thiazides (Bendroflumethiazide)

20
Q

When are Thiazides/Thiazide-like diuretics ineffective, and what is the exception to this?

A

Moderate renal impairment

Metolazone

21
Q

What are the main side effects of Thiazides/Thiazide-like diuretics?

A 
Hypokalaemia
Postural hypotension
Impaired glucose control (diabetogenic)
Urination
Altered lipid profile
Impotence?
22
Q

When should Thiazides/Thiazide-like diuretics never be used?

A

Patients suffering from Gout

23
Q

What should be monitored before and during treatment with Thiazides/Thiazide-like diuretics?

A

Creatinine - indicator of renal function

24
Q

How do Beta-Blockers work?

A

MoA unclear
Reduce sympathetic drive to the heart, reducing CO
Reduce sympathetically evoked renin release

25
Q

What are the main side effects of, and contraindications for, Beta-Blockers?

A

May block bronchial B2 receptors
Contraindicated in asthma, cause bronchospasm
Caution in COPD
Reduce hypoglycaemic awareness

26
Q

Give named examples of Beta-Blockers

A

Atenolol

Propranolol

27
Q

What are the main side effects of Calcium Channel Blockers?

A

Peripheral oedema
Postural hypotension
Constipation (some)

28
Q

What are the key lifestyle changes that should be made when first treating hypertension?

A 
Reduce alcohol consumption
Weight reduction
Reduce excess caffeine
Reduce fat/salt intake
Increase fruit/oily fish in the diet
Increase exercise
Stop smoking
29
Q

How, and when, should hypertension be confirmed?

A

After implementation of lifestyle changes
~14 ambulatory measurements
Home devices, both arms

30
Q

Describe the staging for hypertension

A

Stage 1 - <140/>90
Stage 2 - >160/>100
Severe - >180/110

31
Q

Which patients should be treated with antihypertensive medication?

A 
Stage 1 patients with one or more:
End organ damage
Diabetes
CV disease/high risk CV risk
All Stage 2 patients
32
Q

What are the compelling indications for ACEIs/ATRAs?

A

Heart failure
LV hypertrophy
Diabetic nephropathy

33
Q

What are the contraindications for ACEIs/ATRAs?

A

Renovascular disease

34
Q

What are the compelling indications for Calcium Channel Blockers?

A

Afro-Caribbean ethnicity
DHPs in isolated systolic HT
Diltiazem/Verapamil in angina

35
Q

What Calcium Channel Blockers are contraindicated in CHF?

A

Diltiazem

Verapamil

36
Q

What are the compelling indications for Thiazides/Thiazide-like diuretics?

A

Elderly

37
Q

What are the contraindications for Thiazides/Thiazide-like diuretics?

A

Gout

38
Q

What are the compelling indications for Beta-Blockers?

A

Myocardial Infraction
IHD
CHF

39
Q

What are the contraindications for Beta-Blockers?

A

Asthma/COPD

Heart block

40
Q

What are the compelling indications for Alpha-Blockers?

A

Resistance to other drugs

Prostatic hypertrophy

41
Q

What is the first stage of treatment for <55/non-black/high renin patients?

A

ACEIs/ATRAs

42
Q

What is the first stage of treatment for >55/black/low renin patients?

A

Calcium Channel Blockers

43
Q

What is the second stage of treatment in all patients?

A

ACEIs/ATRAs + Calcium Channel Blockers

44
Q

What is the third stage of treatment in all patients?

A

ACEIs/ATRAs + Calcium Channel Blockers + Diuretic

45
Q

What drugs can be added in stage four of treatment (resistance)?

A

Alpha Blocker
Spironolactone
Diuretic
Beta-Blocker

46
Q

When should the use of statins be considered?

A

All patients at high risk of CVD, even with ‘normal’ cholesterol

A13THP @ UoN (19 decks)

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