Hypertension Flashcards
What is hypertension?
Term to describe increased BP
What is essential HT also known as?
Primary hypertension
What is primary hypertension?
Hypertension that has developed on it’s own, no secondary cause
Secondary Causes of hypertension?
R- renal disease (most common)
O- Obesity
P- Pregnancy induced HT/Pre-eclampsia
E- Endocrine (primarily consider hyperaldosteronism eg Conn’s syndrome)
How do you investigate to see if someone has Conn’s syndrome?
Renin: aldosterone ratio blood test
Complications of hypertension?
Ischaemic Heart Disease Cerebrovascular Accident (stroke/haemorrhage) Hypertensive retinopathy Hypertensive nephropathy Heart Failure
How can a diagnosis be made?
From 24h ambulatory BP or home readings
White coat syndrome?
Increased BP when around Drs and hospitals
Clinical and home readings expected of stage 1 hypertension?
>140/90= clinical >135/85= Home
Clinical and home readings expected of stage 2 hypertension?
> 160/100
>150/95
Medications for HT?
A- ACE inhibitors (ramipril 1.25-10mg once daily)
B- Beta blockers (bisoprolol 5-20mg once daily)
C- Calcium channel blockers (amlodopine 5-10mg once daily)
D- Thiazide like Diuretic (indapamide 2.5mg once daily)
Example of an ACEi?
Ramipril
Example of a beta blocker?
Bisoprolol
Example of a calcium channel blocker?
Amlodopine
Example of a thiazide like diuretic?
Indapamide
What to use if ACEi aren’t tolerated?
ARB
Candesartan
Reasons that an ACEi wouldn’t be tolerated?
Dry cough
Black descent
Who does he medical guidelines differ slightly for in treating HT?
People under age 55
Black people
Medical guidelines for HT?
Step 1: Non-black, under 55 y/o= ACEi. Over 55 y/o or black patients use CCB.
Step 2: Non-black= A+ C. Black use ARB instead of A
Step 3: A + C+ D
Step 4: A + C + D +D
What is spironolactone?
K+ sparing diuretic
What does spironolactone do?
Blocks action of aldosterone in kidneys resulting in Na+ excretion & K+ reabsorption
What is spironolactone helpful for?
When thiazide diuretics cause hypokalaemia
Risk of spironolactone?
Hyperkalaemia aswell as ACEis
Always monitor —– when patients are on diuretics or ACEis?
U&Es
Target for diastolic pressure when treating HT?
Always under 90mmHG
Target systolic pressure for under 80’s?
<140/<90
Target systolic pressure for over 80’s?
<150/<90
BP for diabetics with HT should be around?
<130/<80
Which drug reduces complications in diabetic HT’s?
ACEis (particularly renal)
When are ACEis not first line treatment for diabetic HT?
- Women with child bearing potential - instead use CCB
- Black patients- use ARBs + CCB
