Hypertension Flashcards
what is the first line treatment for hypertension?
ACE inhibitor e.g. ramipril if > 55yrs
CCB e.g. Nifedipine if < 55yrs, pregnant or afro-carribean
describe the management of hypertension?
start with stage 2 hypertension start medication in stage 1 if > 80yrs and one of the following; - organ damage - established CV disease - diabetes - renal disease - 10yr cardiovascular risk 10%
1st line - ACE inhibitor if > 55yrs, CCB if < 55yrs, pregnant or afrocarribean
2nd line - add either ACE inhibitor or CCB
3rd line: thiazide like diuretic
4th line: high dose thiazide like diuretic if K > 4.5 but if K < 4.5 then add spironolactone
why might spironolactone used for 4th line management instead of high dose thiazide like diuretic?
spironolactone is an aldosterone antagonist
it can cause hyperkalaemia
if K is low with the use of thiazide like diuretic (K sparring diuretic) then choose spironolactone instead of high dose TLD in order to increase K to prevent hypokalaemia
describe the treatment of pre-existing hypertension in pregnancy
1st line - labetalol other options; - nifedipine - hydralazine - methyldopa
what are the medication treatment options for pre eclampsia?
20-30mg IV labetalol
5-10mg IV hydralazine
10mg oral nifedipine
when would you start medical management in stage I hypertension?
age > 80 yrs and/or one of the following; - organ damage - established cv disease - diabetes - CKD - 10 year cardiovascular risk 10%
what are side effects of ACE inhibitors?
cough
hyperkalaemia
angiodema
what are the side effects of CCB?
flushing
ankle swelling
headache
what are the side effects of TLD?
hyponatraemia
hypokalaemia
dehydration
what are the side effects of ARB?
hyperkalaemia
definition of orthostatic hypotension ?
drop in SBP by at least 20mmHg and/or drop in DBP by at least 10mmHg when standing for 3 mins
treatment for orhostatic hypotension ?
midodrine or fludrocortisone
