Hypertension Flashcards
What two symptoms might indicate a secondary cause of hypertension?
Haematuria (glomerulonephritis, obstructing urinary tract pathology)
Nocturia (reduced renal function)
What is the mechanism of action of ACE inhibitors?
Reducing levels of the vasoconstrictor, angiotensin II, by reducing the conversion of AI to AII. Increasing levels of vasodilator kinins, causing arteriolar and to a lesser extent venular dilatation, reducing aldosterone secretion which causes naturesis.
What is the suffix of the ACE inhibitors?
- pril
e. g. perindopril etc.
What is the mechanism of action of the Sartans?
Angiotensin II receptor antagonists. Reduce angiotensin-induced vasoconstriction, sodium reabsorption and aldosterone release.
How are the angiotensin II receptor antagonists excreted?
Hepato-biliary excretion
Under what circumstances are beta-blockers indicated?
Recommended for hypertension when there are compelling indications, such as angina. Also after MI.
Not recommended for uncomplicated hypertension.
Name three examples of calcium channel blockers
Amlodipine
Diltiazem
Verapamil
What two classes are the calcium channel blockers divided into?
Dihydropiridines
non-dihydropiridines
Name two non-dihydropiridines
Diltiazem, verapimil
Name four dihydropiridines
nifedipine, felodipine, lercanidipine and amlodipine
What is the difference between the dihydropiridines and the non-dihydropiridines?
Dihydropiridines are more peripherally acting than the non-dihydropiridines. Non-dihydropiridines can depress the sino-atrial and atrio-ventricular nodes and conducting system, which can lead to significant bradycardia.
Examples of thiazide/ thiazide like diuretics?
Thiazides:
- Hydrochlorothiazide
- Chlorothiazide
- etc etc
Thiazide like:
- Chlorthalidone
- Indapamide
Potassium sparing diuretics? (3)
And Type
Aldosterone antagonists
- Spironolactone
- Eplerenone
Epithelial Na Channel Blocker:
- Amiloride
For which patients are beta-blockers contraindicated?
Patients with asthma
In which patients are thiazide diuretics considered for first line treatment of hypertension?
Those aged >65 years in whom the benefits of managing isolated systolic hypertension and preventing stroke with these agents are likely to outweigh the risk of diabetes onset.
Why are thiazide diuretics not considered for treatment of hypertension in young patients?
They are associated with an increased risk of new-onset diabetes
What are three first line treatment options for uncomplicated hypertension?
ACE inhibitor, angiotensin II-receptor antagonist or dihydropyridine calcium channel blocker
In patients with proteinuria >1 g/day (with or without diabetes), what is the recommended BP target?
125/75 mmHg
Which class of antihypertensive drug is contraindicated in patients with heart failure?
Calcium channel blockers. There is a risk of further depression of cardiac function.
Particularly in HFrEF
What percentage of patients with hypertension will not reach target BPs on monotherapy?
50-75%
What is the most effective combination of drugs for the treatment of hypertensive patients who fail to reach target BPs on monotherapy?
ACE-inhibitor (or Angiotensin II receptor blocker) and calcium channel blocker
