Hypertension Flashcards
What are we trying to achieve with controlling hypertension?
Reduction in mortality and morbidity
What is the optimal blood pressure?
Less than 120/75 mmHg
Stricter in diabetes or those with microalbuminuria
What should you consider when managing hypertension?
How hypertension interacts with other risk factors
Other factors; eg: frail patients
When do treatment benefits outweigh side effects?
What contributes to primary or essential hypertension?
RAAS
Sympathetic nervous system = stress
Salt
What are some causes of secondary hypertension?
Renal artery stenosis Pregnancy Hyperaldosteronism Cushing's disease Phaeochromocytoma Sleep apnoea
What is the importance of early blood pressure control?
To prevent progression of hypertension, as relative risk doubles with every increase of 20/10 mmHg
What is the relationship between blood pressure and the progression of chronic kidney disease?
Patients with heart failure with blood pressures that are normal/low are at serious risk of developing chronic kidney disease
What does an increase pulse pressure suggest?
Arteries stiffened
What are non-dippers?
At night, most people’s blood pressure drops = dippers
Non-dippers’ blood pressure doesn’t drop at night
- Very bad sign
- Suggests left ventricular hypertrophy
- Increased risk of sudden death
What does microalbuminuria predict?
If you have albumin leaking in renal arterial bed, then it’s likely that it’s leaking in another arterial bed too
Predicts coronary artery disease independent of diabetes
What is therapeutic inertia?
Failure of physicians to commence new medications/increase dose when abnormal clinical parameter recorded/becomes evident
Involves patient and physician factors
What are the lifestyle modifications that can be made in the treatment of hypertension?
Reduce salt Exercise Cease smoking Reduce weight Reduce alcohol intake
What is a common side effect of ACE inhibitors and angiotensin II receptor inhibitors?
Dry cough because of bradykinin inhibition
Are ACE inhibitors and angiotensin II receptor inhibitors safe in pregnancy?
No
What can happen with dehydration if you’re on ACE inhibitors or angiotensin II receptor inhibitors?
Severe reduction in GFR
What are the indications for beta blockers?
Acute coronary syndrome
Ischaemic heart disease
Heart failure
What are the contraindications for beta blockers?
Peripheral vascular disease
Asthma
Why is the use of beta blockers avoided, if possible?
Increases impaired glucose tolerance
What is a common side effect of calcium channel blockers?
Ankle swelling
Which diuretics are best used in hypertension?
Thiazide diuretics, rather than frusemide
What conditions does hypertension predispose you to?
Coronary heart disease Stroke Cardiac hypertrophy Heart failure Kidney failure
What are the relevant points in the history concerning hypertension?
Family history Past coronary/cerebrovascular events Heart failure symptoms Renal disease symptoms Smoking Diabetes High cholesterol
What are the relevant points in the examination concerning hypertension?
Blood pressure Pulse rate/rhythm Weight and height for BMI Full cardiovascular exam Fundal inspection Renal mass/bruits Stigmata of secondary causes
What are the drug treatments for hypertension?
A = ACE inhibitors and ARBs B = beta blockers C = Ca channel blockers D = diuretics
What is the drug treatment algorithm for hypertension?
1: ACE inhibitor/Ca channel blocker/diuretic
2: ACE inhibitor + Ca channel blocker or diuretic
3: ACE inhibitor + Ca channel blocker + diuretic
When are ACE inhibitors preferred as first line treatment of hypertension?
Less than 55 years
When are Ca channel blockers preferred as first line treatment of hypertension?
Over 55 years
Of African origin
When are diuretics preferred as first line treatment of hypertension?
Fluid retention
What are the general considerations when prescribing ACE inhibitors?
Useful in coronary disease and heart failure
Reno-protective in diabetes
What calcium channel blockers should be avoided in heart failure?
Verapamil
Diltiazam
What are the general considerations when prescribing diuretics?
Thiazide-like drugs have fewer metabolic side effects
