Hypertension Flashcards
what are the values for stage 1 hypertension?
clinic blood pressure 140/90 mmHg or higher
ABPM daytime average 135/85 mmHg or higher
what are the values for stage 2 hypertension?
clinic blood pressure 160/100 mmHg or higher
ABPM daytime average 150/95 mmHg or higher
what are the values for severe hypertension?
clinic systolic blood pressure is 180 mmHg or higher or diastolic blood pressure is 110 mmHg or higher
how does the target blood pressure differ in patients aged over 80 years compared with those aged 55-80 years?
55-80 - target is <135/85
80+ - target is <145/85
what is step 1 in antihypertensive treatment for people aged over 55 / black people of African or Caribbean family origin?
calcium channel blocker (CCB)
in patients where a CCB is not suitable (oedema, intolerance) or there is evidence of heart failure or a high risk of heart failure, what is the alternative?
thiazide-like diuretic
what is the first step in antihypertensive treatment for patients under the age of 55?
ace inhibitor / ARB
what are the contraindications for ACEI / ARB?
afro-caribbean or women of child bearing age
how do you treat resistant hypertension when the blood potassium level is <4.5 mmol/L?
consider further diuretic therapy with low dose spironolactone (25 mg once daily)
how do you treat resistant hypertension when the blood potassium level is >4.5 mmol/L?
consider higher dose thiazide-like diuretic
why should you exercise caution with certain patients when prescribing spironolactone?
people with a reduced estimated GFR may have an increased risk of hyperkalaemia
give an example of an angiotensin converting enzyme inhibitor
ramipril
what are the contraindications of prescribing ACEIs?
renal artery stenosis
renal failure
hyperkalaemia
what are the adverse drug reactions associated with ACEIs?
cough first dose hypotension taste disturbance renal impairment angioneurotic oedema
which other drugs do ACEIs interact with?
NSAIDs (precipitates acute renal failure)
potassium supplements / potassium sparing diuretics (hyperkalaemia)
give an example of an angiotensin II antagonist
losartan
valsartan
candesartan
irbesartan
what is an advantage of using an angiotensin II antagonist over an angiotensin converting enzyme inhibitor?
no cough
give an example of a calcium channel blocker
amlodipine, felodipine (vasodilator)
verapamil, diltiazem (rate limiting)
what are the contraindications of using calcium channel blockers?
acute MI
heart failure, bradycardia (rate limiting CCBs)
what are the adverse drug reactions of calcium channel blockers?
flushing headache ankle oedema indigestion and reflux oesophagitis bradycardia, constipation (rate limiting)
give an example of a thiazide type diuretic
indapamide
clortalidone
what are the adverse drug reactions of thiazide type diuretics?
gout
impotence
give an example of an alpha-adrenoceptor antagonist
doxazosin
give an example of a centrally acting agent
methyldopa
moxonidine
give an example of a vasodilator
hydralazine
minoxidil
what are the adverse drug reactions of alpha-adrenoceptor antagonists?
first dose hypotension
dizziness
dry mouth
headache
what are the adverse drug reactions of centrally acting agents?
sedation and drowsiness
dry mouth and nasal congestion
orthostatic hypotension
how do you treat hypertension in a woman of child bearing age (not yet pregnant)?
nifedipine mr (CCB) methyldopa (CAA) atenolol, labetalol (BB)
how do you treat hypertension once a woman becomes pregnant?
add thiazide diuretic and / or amlodipine (CCB)
how do you treat preeclampsia?
as previous plus IV hydralazine, esmolol, labetalol
how do ACEIs work?
competitively inhibit the actions of angiotensin converting enzyme, which converts angiotensin I to angiotensin II, a potent vasoconstrictor and hypertrophogenic agent (wtv that means)
how do ARBs work?
competitively block the actions of angiotensin II at the angiotensin AT1 receptor
how do CCBs work?
blocking the L type calcium channels
selectivity between vascular and cardiac L type channels
relaxing large and small arteries and reducing peripheral resistance
reducing cardiac output
how do thiazide type diuretics work?
urinary excretion of sodium
resistance vessel dilatation
how do alpha-adrenoceptor antagonists work?
selectively block post synaptic alpha1-adrenoceptors
oppose vascular smooth muscle contraction in arteries
how do centrally acting agents work?
converted to alpha-methylnoradrenaline which acts on CNS alpha adrenoceptors which decrease central sympathetic outflow
