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BNF Chapter 2 - Cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What conditions can one be at a greater risk of if they suffer from hypertension?

A

Stroke, coronary events, heart failure, renal impairment.

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2
Q

What lifestyle changes can be given to someone with hypertension?

A

Smoking cessation, weight reduction, reduction of alcohol and caffeine intake, reduction of salt in diet, reduction of total and saturated fat, increase exercise, increase fruit and veg.

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3
Q

What is normal blood pressure?

A

120/80mmHg.

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4
Q

What is the clinic blood pressure used to define stage 1 hypertension?

A

140/90mmHg.

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5
Q

What is the ABPM/HBPM blood pressure used to define stage 1 hypertension?

A

135/83mmHg.

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6
Q

Which patients with stage 1 hypertension should be treated?

A

Patients under 80 with target-organ damage, CVD, renal disease, diabetes, QRISK grater then 20%.

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7
Q

What is the clinic blood pressure used to define stage 2 hypertension?

A

160/100mmHg.

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8
Q

What is the ABPM/HBPM used to define stage 2 hypertension?

A

150/95mmHg.

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9
Q

Which patient’s with stage 2 hypertension should be treated?

A

All patients.

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10
Q

What is the clinic systolic blood pressure used to define severe hypertension?

A

Greater than 180mmHg.

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11
Q

What is the clinic diastolic blood pressure used to define severe hypertension?

A

Hreater then 110mmHg.

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12
Q

How should severe hypertension be treated?

A

Promptly - hypertensive crisis.

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13
Q

What is the clinic blood pressure target for patients over 80 years of age being treated for hypertension?

A

150/90mmHg.

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14
Q

What is the ABPM/HBPM blood pressure target for patients over 80 being treated for hypertension?

A

145/95mmHg.

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15
Q

What is the clinic blood pressure target for patients under 80 years old being treated for hypertension?

A

140/90mmHg.

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16
Q

What is the ABPM/HBPM blood pressure target for patients under 80 years old being treated for hypertension?

A

135/85mmHg.

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17
Q

What is the clinic blood pressure target for patients with CVD or diabetes in the presence of kidney, eye, or cerebrovascular disease, being treated for hypertension?

A

130/80mmHg.

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18
Q

Describe the steps to the pharmacological treatment of hypertension for a non-black patient under the age of 55 years.

A

1 - ACEi, ARB, or beta-blocker.
2 - ACEi or ARB plus CCB or thiazide-like diuretic, or beta-blocker + CCB.
3 - ACEi or ARB with CCB plus thiazide-like diuretic.
4 - Specialist advice.

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19
Q

Describe the steps to the pharmacological treatment of hypertension for patients over the age of 55 or of black origin.

A

1 - CCB or thiazide-like diuretic.
2 - CCB or thiazide-like diuretic plus an ACEi or ARB.
3 - ACEi or ARB with CCB plus thiazide.
4 - Specialist advice.

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20
Q

What mediations can be used to reduce the cardiovascular risk of a patient with hypertension?

A

Aspirin in primary prevention is of unproven benefit. Primary prevention with a statin is recommended.

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21
Q

If a patient has diabetes and hypertension, why is the used of an ACEi or ARB recommended?

A

The use of an ACEi or ARB is recommended, regardless of blood pressure, to minimise the risk of renal deterioration. Use with caution in renal impairment.

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22
Q

Which medications are considered safe for use in hypertension in pregnancy?

A

Labetalol and methyldopa.

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23
Q

In uncomplicated chronic hypertension in pregnancy, what is the target blood pressure?

A

< 150/100mmHg.

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24
Q

What is a hypertensive crisis described as?

A

Severe hypertension with acute damage to the target organs.

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25
Q

What treatment is advised for a hypertensive crisis?

A

Prompt treatment with IV hypertensives.

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26
Q

What change in blood pressure should be seen when treating a hypertensive crisis?

A

A 20-25% reduction in the first few minutes to two hours.

27
Q

Which side-effects of antihypertensives should be cause for immediate referral?

A

Water retention, heaviness in the centre of the chest triggered by effort or emotion, depression, extreme tiredness, thirst, excessive urination, irregular heartbeat, muscle weakness, nausea, pain or tiredness in the legs when exercising, dizziness, light-headedness on standing, blurred vision.

28
Q

What monitoring is required when using antihypertensive drugs?

A

BP, HR, renal function, serum electrolytes.

29
Q

Use of which antihypertensive drugs with high dose statins can increase one’s risk of myopathy?

A

Diltiazem, verapamil, amlodipine, ranolazine.

30
Q

What is the max recommended dose of simvastatin to be used alongside antihypertensive drugs?

A

20mg.

31
Q

An increased plasma concentration of which antihypertensive drugs is seen when taken with grapefruit juice?

A

Ivabradine, aliskerin, CCBs.

32
Q

How should a patient be counselled to reduce the effects of postural hypertension in the morning, when taking antihypertensives?

A

Sitting and standing up slowly.

33
Q

What formulation of drugs should be avoided in patients with hypertension? Why?

A

Soluble/effervescent preparations as they contain a high amount of sodium.

34
Q

Which CCBs should be prescribed by brand?

A

Diltiazem and verapamil.

35
Q

When drugs affecting the RAAS are initiated, careful clinical monitoring is required in which patients?

A

Severe heart failure, patients on multiple or high dose diuretics, patients on ARBs or aliskiren, patients with hypovolemia, patients with hyponatraemia, patients with hypotension, patients with unstable heart failure, patients receiving high dose vasodilators, patients with known renovascular disease.

36
Q

Why are ACEis best avoided in patients with known or suspected renovascular disease?

A

Due to risk of hyperkalaemia.

37
Q

If ACEis are used in patients with known or suspected renovascular disease under specialist supervision, what requires monitoring?

A

Renal function requires monitoring regularly.

38
Q

Use of which drugs alongside ACEis can increase one’s risk of renal damage?

A

NSAIDs.

39
Q

Use of which drugs alongside ACEis can increase one’s risk of hyperkalaemia?

A

Potassium-sparing diuretics.

40
Q

What causes the dry cough often seen with patients newly started on ACEis?

A

A build-up of bradykinin.

41
Q

To avoid anaphylactoid reactions, when should ACEis not be given?

A

During dialysis with high-flux polyacrylonitrile membranes and low-density lipoprotein apheresis with dextran sulphate, they should also be withheld before desensitisation with wasp or bee venom.

42
Q

When used with diuretics, what dose of diuretic should be cause for administration of ACEis under close supervision?

A

Greater then 80 mg furosemide or equivalent.

43
Q

If jaundice or marked elevations in hepatic enzymes occur during ACEi treatment, what should be done? Why?

A

Drugs withdrawn due to risk of necrosis.

44
Q

Why is concomitant use of two or more drugs affecting the RAAS recommended? Who is at a higher risk?

A

Increased risk of hyperkalaemia, hypotension, renal impairment. Patient’s with diabetic nephropathy are at a greater risk.

45
Q

What feature of beta-blockers leads to them causing less bradycardia and less coldness of the extremities?

A

Intrinsic sympathomimetic activity.

46
Q

Which beta-blockers are least likely to cause sleep disturbance and nightmares? Why?

A

Atenolol and sotalol. They are most water soluble so less gets into the brain.

47
Q

Why may the use of beta-blockers be of concern in patients with diabetes?

A

They may block the symptoms of hypoglycaemia.

48
Q

Beta-blockers can cause changes in blood sugars, how?

A

By affecting carbohydrate metabolism in both diabetic and non-diabetic patients.

49
Q

Why should beta-blockers, including those considered cardio-selective, be avoided in patients with asthma?

A

They can cause bronchospasm, leading to asthma attacks.

50
Q

When there is no alternative treatment, which beta blockers can be used in patients with asthma or a history of bronchospasm, under specialist supervision and caution?

A

Atenolol, bisoprolol, metoprolol, nebivolol.

51
Q

Bradycardia may be experienced when beta-blockers are given IV, what symptoms may be experienced by the patient in this instance?

A

Light headedness, dizziness, syncope (loss of consciousness caused by blood pressure).

52
Q

What drug may be given to counter the bradycardia experienced when beta-blockers are given IV?

A

IV atropine.

53
Q

Why should verapamil and beta-blockers not be given concomitantly?

A

Risk of hypotension and asystole.

54
Q

What specific monitoring is required when a patient is prescribed labetalol? Why?

A

Liver function monitoring due to risk of severe hepatocellular damage associated with both long- and short-term use.

55
Q

If hepatotoxicity occurs with labetalol use, what should be done?

A

Drug immediately discontinued permanently.

56
Q

Why should verapamil and diltiazem be avoided in heart failure?

A

They may further depress cardiac function and cause clinically significant deterioration.

57
Q

Do different MR preparations of nifedipine have the same clinical effect?

A

Not always.

58
Q

In what conditions may modified release preparations of nifedipine not be appropriate?

A

Hepatic impairment, history of oesophageal or GI obstruction, decreased lumen diameter, IBD, ileostomy after proctocolectomy.

59
Q

Use of sympathomimetic inotropes and vasoconstrictors for the treatment of shock should be confined to which setting?

A

Intensive care with invasive haemodynamic monitoring.

60
Q

Is shock a medical emergency?

A

Yes.

61
Q

Give some examples of sympathomimetic vasoconstrictors.

A

Noradrenaline and phenylephrine.

62
Q

What is the danger of using vasoconstrictors?

A

Whilst they can raise BP, they can reduce perfusion to key organs such as the kidneys.

63
Q

What may be seen due to the longer duration of action seen with phenylephrine compared to noradrenaline?

A

A prolonged rise in blood pressure.

64
Q

When is adrenaline used?

A

In CPR for cardiac arrest by IV under specialist care.

BNF Chapter 2 - Cardiology (10 decks)

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