Hypertension (finals) Flashcards
What is the definition of hypertension
Clinic reading above >140/90
OR
A 24 hour blood pressure average of >135/85
What investigations should be done to check for end organ damage if someone is hypertensive
Fundoscopy - Hypertensive retinopathy
Urine dipstick - Renal disease (as a cause or consequence of HTN)
ECG - To check for LVH or IHD
What is an ACE inhibitor
Inhibits the conversion of angiotensin I to angiotensin II
End in ‘pril’
What are the side effects of ACE inhibitors
Cough
Angioedema
Hyperkalaemia
*Check renal function 2-3 weeks after starting due to the risk of worsening renal function in those with kidney disease
What are calcium channel blockers
They block voltage-gated calcium channels which relaxes vascular smooth muscle and relaxes the force of myocardial contraction.
What are the side effects of calcium channel blockers
Flushing
Angle swelling
Headache
What are thiazide type diuretics
They inhibit sodium absorption at the beginning of the distal convoluted tubule
What are the side effects of thiazide type diuretics
Hyponatraemia
Hypokalaemia
Dehydration
What are angiotensin II receptor blockers
Block the effects of angiotensin II at the AT1 receptor
End in ‘sartan’
What are the side effects of Angiotensin II receptor blockers
Hyperkalaemia
What is stage 1 hypertension
Clinic >140/90
ABPM or HBPM >135/85
What is stage 2 hypertension
Clinic BP >160/100
ABPM or HBPM >150/95
What is severe hypertension
Clinic systolic >180
Clinic diastolic > 120
What is the treatment for stage 1 hypertension
Treat if <80 AND: Target organ damage, established cardiovascular disease, renal disease, 10 year cardiovascular risk >10%
If <40 - consider specialist evaluation
What should be done for stage 2 hypertension
Treat all patients regardless of age
What is first line HTN treatment
Patient <55 years OR type 2 diabetes:
ACE inhibitor OR Angiotensin receptor blocker
(ARB used when ACE is not tolerated)
Patients > 55 or black African or afrocaribbean:
Calcium channel blocker
What is second line treatment for HTN
Already taking ACE or ARB - Add CCB or TLD
If already taking CCB - Add ACE, ARB or TLD
Afrocaribbean - If already taking a CCN, consider an ARB next instead of an ACE
What is third line treatment for HTN
If already taking ACE and CCB - Add TLD
If already taking Ace and TLD - Add CCB
What is fourth line treatment for HTN
step 4 = resistant hypertension.
Tests:
- Confirm HTN
- Assess postural hypotension
- Discuss adherence
If potassium <4.5 - add low dose spironolactone
If potassium > 4.5 - add alpha or beta blocker
What is the blood pressure targets
< 80
- Clinic 140/90
- Home 135/85
> 80
- 150/90
- 145/85
Who should receive a statin
Anyone with a 10 year cardiovascular risk of >10%
Statins should be taken at night
What are common ACE inhibitors
Lisinopril
Captopril
Enalapril
Ramipril
Peridopril
Fosinopril
What are examples of ARBs
Candesartan
Azilsartan
Losartan
Eprosartan
Valsartan
Olmesartan
What are examples of thiazide like duiretics
Indapamide
Chlortalidone
Xipamide
What type of drug is bendroflumethiazide
A thiazide diuretic
What are examples of Calcium channel blockers
Dihydropyridine:
Amlodipine
Felodipine
Lacidipine
Nicardipine
Lercanidipine
Nifedipine
Rate limiting:
Verapamil
Diltiazem
