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308: Clinical pharmacology and therapeutics > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Hypertension definition

+ diagnosis

A

Sustained blood pressure >140/90
ABPM/HBPM= >135/85

Diagnosing

  • Take second BP
  • If different, take another measurement, and lower of the 2.
  • Clinical BP 140-180= ambulatory BP monitoring to confirm HTN/ HBPM
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2
Q

White coat hypertension

A

HTN in clinic but not ABPM/ HBPM

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3
Q

ABPM

A

24 BP monitoring when moving

- Takes BP twice everyday, once at night

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4
Q

HBPM

A

Home blood pressure monitoring

2 seated measurements

twice a day for at least 4 days
- Discard first day measurement. Average of the rest.

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5
Q

Masked Hypertension

A

Normotensive in clinic

Hypertension ABPM/ HBPM

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6
Q

Hypertension causes

  • Primary
  • Secondary
A

Primary (90%)
- Polymorphic: if family member has it= increased risk

Secondary
- Renal disease (most common), renovascular (RA stenosis), renal parenchymal

  • Endocrine: Conn’s, Cushings, Phaeochromocytoma
  • Drugs: COCP pills, steroids, NSAIDs, cocaine, EPO, SSRI, tacrolimus
  • Vascular: co-arctation of aorta (radio-femoral delay)
  • Others: OSA, pregnancy
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7
Q

Contributory factors to HTN

A

High BMI

High alcohol consumption

Salt intake

Inactivity

Stress

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8
Q

Risk factors of HTN

A

Male sex

Age (>75, 1 in 2)

FH, black African ethnicity

Smoking

Hypercholesterolaemia

Diabetes.

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9
Q

Hypertension examination

A

CV

  • Radio femoral delay
  • Displaced apex

Abdominal

Opthalmoscopy
- Hypertensive renal disease

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10
Q

Hypertension investigations

- Assessing for organ damage

A

Urinalysis

  • Proteinuria
  • Haematuria

ECG

  • LV hypertrophy
  • AF

Blood tests

  • U+Es: renal disease
  • LFT:
  • Lipid profile
  • Glucose/ HbA1c: diabetes
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11
Q

Management of ABPM/ HBPM= 135/95-149-94
CBPM= 140/90-179/119
(Stage 1 HTN)

A
  1. Offer lifestyle advice
    - Weight loss
    - DASH diet
    - Exercise
    - Restriction Na
    - Alcohol moderation
  2. If organ damage/ CVD/ renal disease/ diabetes/ QRISK>20 = drug treatment
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12
Q

Management of ABPM/ HBPM=> 150-95
CBPM= >180/120
(Stage 2 HTN)

A
  1. Antihypertensive drug treatment + lifestyle modification
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13
Q

Indications for drug treatment in HTN

A

Stage 1 HTN + evidence of disease

Stage 2 HTN

Severe hypertension (CBP >180/120)

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14
Q

Antihypertensive drug treatment

A
  1. T2 DM, Age <55, not Black
    - ACEi
    - ARB
  2. Not T2 DM, Black, >55
    - CCB
  3. Add CCB or Thiazide
  4. Add ACEi/ ARB or thiazide
  5. All drug types
  6. Resistant hypertension if all 3 drugs do not work
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15
Q

Amlodipine side effect

A

Leg swelling

Constipation

Headaches

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16
Q

ACEi and ARB monitoring

A
  1. Before starting
    - RFT: check serum creatinine, K
    - Do not start drug if >K
  2. After starting
    - If creatinine >30 or GFR falls >25%= stop drug
    - Repeat test, consider other causes
    - Co-prescribe with spironolactone
17
Q

Antihypertensive in pregnancy

A

ACEi/ ARBs are contraindicated in pregnancy and pregnancy

Alternatives

  • Labetalol
  • Methyldopa
  • Nifedipine/ amlodipine
18
Q

Proteinuria treatment targets

A

ACR < 70, PCR<100
- Target BP 140/90

ACR> 70, PCR>100
- Target BP <130/80

Start ACEi/ ARBi

19
Q

Resistant hypertension treatment

A

Low dose spironolactone if K< 4.5

Alpha-blocker/ beta-blocker if K>4.5

  • Doxazosin
  • Labetalol/ bisoprolol
20
Q

Hypertensive emergency

A

Severe hypertension cause acute target organ damage

Symptoms

  • Chest pain
  • Dyspnoea
  • Neurological deficit
21
Q

Statin for primary intervention of CVD

A

40-84 with CVD risk > 10%

Diabetes, CKD, familial hypercholesterolaemia

22
Q

Monitoring before statin

A

Lipid profile

LFTs

Renal function

HBA1c

TSH

23
Q

Follow up after statins

A

3 months later

  • Lipid profile (efficacy)
  • LFT
  • CK if symptomatic

Annual medication review

24
Q

Hypertrigylcerridaemia

A

TG> 10
- Increases risk of pancreatitis

Refer to specialist >20
- Treated with fibrates/ omega 3

308: Clinical pharmacology and therapeutics (13 decks)

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