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Year 3 Top Tips > Hypertension Management > Flashcards

Hypertension Management Flashcards

1
Q

What are the actors that affect the choice of antihypertensive drugs?

A
  • cardiovascular risk profile
  • coexisting disorders/risk factors
  • target organ damage
  • Interaction with other drugs used for concomitant conditions
  • tolerability of the drug
  • cost of the therapy
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2
Q

WHat are the categories of blood pressure?

A
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3
Q

What si the BP treatment for elderdy patients over 80 yrs

A

same treatment as people aged >55 yrs taking into account of co-morbidities

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4
Q

For elderly when do you start treating hypertension?

A

Treat to <150/90

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5
Q

Step 1 hypertension treatment recommendation for people <55 yrs

A

ACE inhibitor

OR low cost ARB

If an ACE inhibitor is used and is not tolerated, offer an ARB

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6
Q

What should you NOT do in treatment for hypertensive patients?

A

Combine Ace inhibitors with and ARB

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7
Q

Step 1 hypertension treatment recommendation for people >55 yrs

A

CCB

If CCB is not suitable ie due to oedema or intolerance, or if there is evidence of HF, or high risk of HF offer thiazide like diuretic

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8
Q

Why is CCB prefreed to diuretic in hypertension

A

CCB (usually amlopdipine)- most cost effective tx option for hypertension unless patient had HF.

CCB is metabolically neutral- easy to use

CBB is best at reducing BP Variability

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9
Q

When can beta blockers be used in hypertensive patients?

A

can be considered in younger patients paticularly:

  • those with intolerance or contrindication to ACE inhibitors and ARBs or
  • women of child bearing potention or
  • oeiple with evidence of increased sympathetic drive.
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10
Q

What should you add if you give patient a beta blocker for hypertension and why?

A

CCB rather than thiazide- like diuretic to reduce the persons risk of developing diabetes

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11
Q

Step 2 hypertension treatment recommendation

A

offer CCB with combination of ACE inhibitor or an ARB

offer thiazide like diuretic if risk of HF

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12
Q

Step 3 hypertension treatment recommendation

A

If treatment with three drugs is required, the combination of ACE inhibitors or an ARB + CCB + thiazide like diuretic should be used

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13
Q

Step 4 hypertension treatment recommendation

A

This is known to be resistant hypertenision

add a fourth antihypertensive drug

If blood K levels are:

    • > than 4.5 mmol/l consider therapy addition with higher dose thiazide- like diuretic treatment
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14
Q

Quick summary of hypertensive treatments =

A
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15
Q

What happens if hypertension is not controlled?

A

LVH

HF

CKD

Stroke

Vascular dementia

Retinopathy

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16
Q

Which antihypertensive drugs would you avoid with people with diabetes?

A

Diuretic

beta blockers

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17
Q

Which antihypertensive drugs would you avoid with people with dislipidaemia?

A

diuretics

beta blockers

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18
Q

Which antihypertensive drugs would you avoid with people with HF?

A

beta blockers

CCB

19
Q

Which antihypertensive drugs would you avoid with people with asthma/COPD?

A

ACE inhibitors

Beta blockers

20
Q

Which antihypertensive drugs would you avoid with people with Peripheral vascular disease?

A

Beta blockers

ACE inhibitors

All antagonists

21
Q

Which antihypertensive drugs would you avoid with people with Renal artery stenosis?

A

Ace inhibitors

all antagonists

22
Q

Preferred antihypertensive drugs for pregnancy

A

Nifedipine, labetalol, hydralazine, betablcokers, methyldopa,prazosin

23
Q

Preferred antihypertensive drugs for Coronary heart disease

A

Beta-blockers, ACE inhibitors, Calcium channel blockers

24
Q

Preferred antihypertensive drugs for Congestive heart failure

A

Ace inhibitors

beta blockers

25
Q

SE of diuretics?

A
26
Q

SE of beta blockers?

A
27
Q

SE of CCB

A

pedal edema

headache

28
Q

SE of alpha blockers

A

postural hypotension

29
Q

SE of Angiotensin II receptor Blockers

A

headache dizziness

30
Q

What is microalbuminuria?

A

refers to a level of urinary albumin excertion, commonly defined as being between 30 and 299mg albumin per day and below the sensitivity threshold of conventional dipsticks

-It is usually detected by measuring the albumin-creatinine ratio either in a spot urine sample or in a timed urine collection

31
Q

What is the significance of microalbuminuria?

A

considered the earliest detectable stage of diabetic nephropathy

32
Q

Sign and symtoms of acute, ongoing target organ damage?

A

Brain (headache, confusion, stroke, agitation, seizure) Eyes (papiloedema) Heart (chest pain, SOB) Kidney (urinalysis, renal function)

33
Q

Headaches, confuson, agitation and seizure are all features fo what?

A

hypertensive encephalopathy

34
Q

What are we looking for in the eyes for emergency hypertension?

A

papilloedema hypertensive retinopathy haemorrhages

35
Q

Emergency Hypertension Cardiac signs to look out for?

A

acute coronary syndrome pulmonary oedema acute left ventricular failure

36
Q

Emergency Hypertension What to look out for in urinanalysis?

A

Haematuria

37
Q

Management for emergency hypertension

A

gradually lowering BP over 24 hours -10% first hour -Further 5-15% subsequent 23 hours -No more than 25% in first 24 hours

38
Q

What are there exception to gradually lowering BP over 24 hours for emergency hypertension?

A

Acute phase of ischaemic stroke Haemorrhagc stroke Acute aortic dissection

39
Q

What is the risk of dropping the blood pressure too quickly?

A

Autoregulation occurs in most organs which means that vascular bed within that organ has adapted to be under high levels of pressure. So you can actually cause a reband ischaemic episode fi you suddenly then drop the blood pressure.

40
Q

What are some neurological emergencies related to hypertension

A

Ischaemic stroke- may want to lower it for thrombolysis

Haemorrhagic stroke- risk vs benefit

head injury

Hypertensive encephalopathy

41
Q

What are some cardiac emergencies related to hypertension

A

Heart failure- acute LV dsyfunction and plumonary oedema

ACS

42
Q

What are some Vascular emergencies related to hypertension

A

Acute aortic dissection- goal systolic of 100 to 120 mmHg within 20 minutes, HR 60 bpm labetolol

43
Q

What are some Renal emergencies related to hypertension

A

Acute hypertensive enphrosclerosis

Haematuria

Elevated creatinine

44
Q

What are the treatment options for emergency hypertension?

A

Year 3 Top Tips (19 decks)

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