Hypertension and Hyperlipidaemia Flashcards
What level is diagnostic of mild HTN?
140/90
What level is diagnostic of moderate HTN?
160/100
What level is diagnostic of severe HTN?
>180/110
What are the risk factors for primary HTN?
Smoking
Diabetes
>Age
Obesity
FH
Previous MI
Alcohol intake
Male
What percentage of HTN cases are primary?
90%
What are the causes of secondary HTN?
Renal artery stenosis
Pre-Eclampsia
NSAIDS
Combined Contraceptive Pill
Cushing’s
Conn’s Disease
Co-Arctation of the aorta
Diabetes
Pregnancy
Pheochromocytoma
When should secondary HTN be considered?
If patient is not responding to treatment
What investigations are used in the diagnosis of HTN?
Repeat BP measurements over time
24 Ambulatory BP Monitoring
- White coat hypertension
- If BP inconclusive
Name some complications of HTN
Stroke and cognitive decline
MI
HF
Renal failure/Proteinuria
Retinopathy
What is the non-pharmacological management of HTN?
Weight loss
Diet
What is the pharmacological management of HTN in >55 or Afro-Caribbeans?
CCB
CCB + ACEI/ARB (prefered ARB in African Carribean origin) or thiazide diuretic
ACEI + CCB + Thiazide diuretic
+ Low dose spirnolactone if K less than 4.5
or B/A blocker if K more than 4.5
Specialist review if not controlled on 4 drugs
What is the pharmacological management of <55?
ACEI/ARB
ACEI + CCB or thiazide diuretic
ACEI + CCB + thiazide diuretic
+ Low dose spirnolactone if K less than 4.5
or B blocker if K more than 4.5
Specialised review if not controlled on 4 drugs
What is the first line hypertensive medication in diabetics, regardless of age?
ACEI
Due to renoprotective effect
What is the mechanism of action of ACEI?
Angiotensin converting enzyme inhibitor
Prevents angiotensin 1 converting to angiotensin 2
So less vasoconstriction
Also causes Na excretion and H2O release
Give side effects of ACEI
Dry cough
Urticaria
Hyperkalaemia
Angioedema, resulting in swollen tongue and lips
First dose hypotension
Dizziness
Give contraindications of ACEI
Pregnancy and breastfeeding
Renovascular disease, may result in renal impairment
Aortic stenosis, may result in hypotension
Hereditary of idiopathic angioedema
What monitoring should be involved with ACEI?
Rise in creatinine and K should be expected
Significant renal impairment in patients with undiagnosed renal artery stenosis
Give possible drug interactions with ACEI
High dose diuretic therapy, significantly increases hypotension risk
What is the mechanism of action of CCB?
Reduce cell entry of Ca via voltage sensitive channels
As Ca causes contractions, reducing this leads to relaxation of muscles
Give an example of a CCB
Amlodipine
Verapamil
Give side effects of CCB
Ankle oedema
Flushes
What is the mechanism of action of B Blockers?
Blocks adrenalin from reaching B1
So slows heart rate down
But can also block B2 in lungs
Give side effects of B-Blockers
Cold peripheries
Bronchospasms, contraindicated in asthma
Bradycardia
Hypotension
Erectile dysfunction
Fatigue/sleep disturbance, including nightmares
Reduce hypoglycaemic awareness
Give contraindications of B Blockers
Uncontrolled heart failure
Asthma
Sick sinus syndrome
Concurrent verapamil use, may precipitate severe bradycardia
What is the mechanism of action of thiazide diuretics?
Inhibit the sodium/chloride co-transporter
Give an example of a thiazide diuretic
Bendroflumethiazide
Indapamide
Give side effects of thiazaide diuretics
Postural hypotension
Hypokalaemia, causing heart block
Hyponatraemia
Hypercalcaemia, causing constipation, renal stones
Impaired glucose tolerance
Impotence/sexual dysfunction
Agranulocytosis
Dehydration
Gout
Photosensitivity rash
Pancreatitis, rare complication
Precipitate digoxin toxicity
What is malignant hypertension?
Medical emergency involving fibrinoid necrosis of arterioles and dilation of cerebral arteries
Describe the presentation of malignant HTN
Headache
Vomiting
Visual disturbance
Convulsions
Papilloedema
What is the management of malignant HTN?
IV Labetalol
Name some complications of malignant HTN
Microangiopathic haemolytic anaemia
Renal failure
Cerebral haemorrhage
Coma
Death
What is hyperlipidaemia/dyslipidaemia?
Raised levels of cholesterol and triglycerides within the blood, associated with increased cardiovascular risk
What is familial hypercholesterolaemia?
Autosominal dominant elevation of cholesterol, leading to earlier development of cardiovascular disease
How does hyerlipidaemia present?
Tendon xanthomata
Xanethelasma
What is orthostatic hypotension?
Diagnosed when there is a drop in systolic BP of at least 20 mmHg and/or a drop in diastolic BP of at least 10 mmHg after 3 minutes of standing
What can be used in the management of orthostatic hypotension?
Advise patient to stand slowly, dorsiflexing the feet before standing upiright
Fludrocortisone, first line drug
Midodrine
