Hypertension Flashcards
What is Resistant Hypertension?
> 140/90 after step 3 of treatment
How is Resistant Hypertension treated?
Either refer to specialist OR Spironolactone if K high OR High dose Thiazide
What are target BPs in hypertension?
>80 = 150/90 <80 = 140/90
What bloods must you check before starting ACEi?
U and E
What is stage 1 hypertension?
140/90 in clinic
135/85 ambulatory
What stage do you start hypertension treatment at?
Stage 2 regardless of age (bp 150) if no cormorbidities
If there are comorbidities start at 140
What is stage 2 hypertension?
160/100
150/95 ambulatory
What is stage 3 (severe) hypertension?
> 180 in clinic
>110
What investigation indicated in severe hypertension
Fundoscopy
What is the risk score used to decide on statins?
QRisk2
What is lifestyle advice offered to people with hypertension?
Weight Loss Excercise Lower sodium Reduce alcohol and caffeine intake Stop smoking Check cholesterol
What investigations should be done in all hypertension?
ECG
BMI
Blood glucose
How should you respond to severe hypertension in clinic?
Treat immediately
Assess carefully for neurological signs
What is the 1st and 2nd and 3rd line management of hypertension for under 55 year old man?
1st line= ACEi or ARB
2nd line= ACEi (or ARB) + CCB
3rd line= ACEi + CCB + Thiazide like Diuretic
What is the 1st and 2nd and 3rd line management of hypertension in an afro caribbean man over 55?
1st line= CCB
2nd line= ACEi + CCB
3rd line= ACEi + CCB + Thiazide like Diuretic
When do patients generally notice symptoms in hypertension?
Not until organ damage
When would you start pharmacological treatment for stage 1 hypertension?
Over 50
Organ damage
DM
What are some causes of secondary hypertension?
Cushings Renal Disease Conns Phaeochromocytoma Hyperparathyroidism Pregnancy (Alcohol and obesity)
What investigations would you do in hypertension?
Cr Electrolytes eGFR Glucose HbA1c Lipid Profile Urine ECG and echo if risk
When would you offer a statin?
In CVD and hypertension
OR
>40 with hypertension and 10 year CVD risk of 20%
Name some CCBs
Amlodipine
Nifedipine
Name some ACEi
Enalapril
Ramipril
Lisinopril
Name some ARBs
Losartan
Condesartan
What is a risk of a Thiazide like diuretic?
Pitting Oedema and Gout
What must be checked before starting statin therapy?
LFTs
When should you review in hypertension?
1 month after starting meds then evert 3-6 months
What is the mechanism of action of ACEi?
Vasodilators
Decrease ECF volume by reducing Aldosterone
What are side effects of ACEi?
Bradykinin cough
Angioedema
Hypokalaemia due to action on Aldosterone
What is the mechanism of Thiazide like Diuretics?
Stop aldosterone release from adrenal medulla therefore reducing expression of the ENaC in distal tubule
What is the mechanism of action of CCBs?
Vasodilate
Reduced tachycardia
What is polypharmarcy
More than 4 drugs in those over 65
What is the impact of polypharmacy?
Increased ADRs
Costs
Less adherence
