Hypertension and Therapy Flashcards
Define HYPERTENSION (HTN):
BP Above which the Benefits of Treatment Outweigh the Risks in Terms of Morbidity and Mortality
Does Blood Pressure (BP) remain CONSTANT throughout the day?
No, it is a Continuous Variable which Fluctuates Widely, i.e. due to Physical and/or Mental Stressors
What did the FRAMINGHAM STUDY indicate?
> BP Associated with Exponential > in Risk of Stroke and CVS Disease
Age is a Significant Variable
What is considered an OPTIMUM BP?
< 120/<80 mmHg
According to NICE 2011, what is CLINICALLY considered to be STAGE 1 HTN?
BP: 140/90 mmHg or Higher
According to NICE 2011, what is CLINICALLY considered to be STAGE 2 HTN?
BP: 160/100 mmHg or Higher
According to NICE 2011, what is CLINICALLY considered to be SEVERE HTN?
BP: 180/110 mmHg or Higher (Systolic and Diastolic considered independently, also)
What is a more PRECISE way of MEASURING BP among HTN patients?
Domiciliary and Ambulatory BP Monitoring (Over 24hrs)
- Stage 1 HTN = 135/85 mmHg
- Stage 2 HTN = 150/95 mmHg
What is the CAUSE of PRIMARY HTN?
Idiopathic (95% of Cases)
What are the CAUSES of SECONDARY HTN?
5-10% of Cases
1) Chronic Renal Disease
2) Endocrine Disease,
i. e. Cushing’s Syndrome
3) Pregnancy, i.e. Pre-eclampsia
4) Congenital Vascular Defects, i.e. Coarctation of the Aorta
5) Sleep Apnoea
What are the RISK FACTORS for HTN?
1) Smoking
2) Diabetes
3) Renal Disease
4) Male
5) Hyperlipidaemia
6) Previous MI or Stroke
7) LV Hypertrophy
8) Family History
What PHYSIOLOGICAL MECHANISMS must be MANIPULATED to control acute and chronic HTN?
1) Cardiac Output
- Heart Rate
- Stroke Volume
2) Peripheral Vascular Resistance
3) Sympathetic Activation
4) Renin-Angiotensin-Aldosterone System (RAAS)
What are the LIKELY CAUSATIVE FACTORS in the AETIOLOGY of HTN?
1) > Reactivity of the Resistance Vessels = > Peripheral Resistance
- Hereditary Tendency for Smooth Muscle to Proliferate
2) Na+ Homeostatic Effect
- Kidneys Unable to Secrete Na+ Properly; Causing Retention of Na+ and H2O and > BP
What are the OTHER FACTORS in the AETIOLOGY of HTN?
1) Age
2) Genetics
3) Environment
4) Weight
- Obesity and Low Birth Weight
5) Diet and Salt Intake
5) Alcohol Intake
6) Race
- > Risk Amongst Black Populations
What is the MOST IMPORTANT NON-PHARMACOLOGICAL measure to < HTN?
Weight Reduction
What DIAGNOSTIC TOOL can be used to ASSESS a patient’s RISK of HTN?
ASSIGN Score
Which APPROACH is used in the MANAGEMENT of HTN?
Stepped Approach
What are the PRINCIPLES of the STEPPED APPROACH to treating HTN?
1) Use Low Doses of Several Drugs
2) Do Not Continuously Change Antihypertensive Meds
3) Add a New Medication to Current Therapy Until Target BP is Achieved
4) Minimise Adverse Events
5) Maximise Patient Compliance
What is the STEP 1 treatment for a patient < 55 YEARS OLD and/or NOT OF AFRO-CARIBBEAN origin and/or NOT of CHILD-BEARING age?
ACE Inhibitor (i.e. Ramipril) or ARB (i.e. Losartan)
What is the STEP 1 treatment for a patient > 55 YEARS OLD and/or of AFRO-CARIBBEAN origin and/or of CHILD-BEARING age?
Ca2+ Channel Blocker (CCB) (i.e. Amlodipine)
Unless Intolerant or with History/Risk of Heart Failure.
Otherwise - Thiazide-Like Diuretic
What is STEP 2 Treatment?
*Cohort Dependent
CCB + Thiazide-Type Diuretic (i.e. Indapamide)
OR
ACE/ARB + Thiazide
What is STEP 3 treatment?
Triple Therapy
- ACEI + CCB + Diuretic
What is STEP4 treatment?
Consider Adding Spironolactone to Triple Therapy, if Blood K+ Levels are Normal
> Dose of Thiazide-Type Diuretic if Hyperkalaemic
What are some of the CONTRAINDICATIONS for ACEI/ARB use?
Renal Failure/Artery Stenosis
Hyperkalaemia
What TYPES of drugs INTERACT with ACEIs?
1) NSAIDS
2) K+ Supplements
3) K+ Sparing Diuretics (i.e. Spironolactone)
Why is the use of CCBs BENEFICIAL in ELDERLY populations with HTN?
1) < Systolic HTN
2) Rarely Causes Postural Hypotension
What is the MAIN TREATMENT of choice for HTN during PREGNANCY?
Nifedipine or Methyldopa
Has a Sustained and Modified Release
What is a COMMON SIDE EFFECT of METHYLDOPA use during pregnancy?
Post-Partum Depression (PPD)
