Hypertension Management Flashcards
What are the actors that affect the choice of antihypertensive drugs?
- 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
WHat are the categories of blood pressure?
What si the BP treatment for elderdy patients over 80 yrs
same treatment as people aged >55 yrs taking into account of co-morbidities
For elderly when do you start treating hypertension?
Treat to <150/90
Step 1 hypertension treatment recommendation for people <55 yrs
ACE inhibitor
OR low cost ARB
If an ACE inhibitor is used and is not tolerated, offer an ARB
What should you NOT do in treatment for hypertensive patients?
Combine Ace inhibitors with and ARB
Step 1 hypertension treatment recommendation for people >55 yrs
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
Why is CCB prefreed to diuretic in hypertension
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
When can beta blockers be used in hypertensive patients?
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.
What should you add if you give patient a beta blocker for hypertension and why?
CCB rather than thiazide- like diuretic to reduce the persons risk of developing diabetes
Step 2 hypertension treatment recommendation
offer CCB with combination of ACE inhibitor or an ARB
offer thiazide like diuretic if risk of HF
Step 3 hypertension treatment recommendation
If treatment with three drugs is required, the combination of ACE inhibitors or an ARB + CCB + thiazide like diuretic should be used
Step 4 hypertension treatment recommendation
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
Quick summary of hypertensive treatments =
What happens if hypertension is not controlled?
LVH
HF
CKD
Stroke
Vascular dementia
Retinopathy
Which antihypertensive drugs would you avoid with people with diabetes?
Diuretic
beta blockers
Which antihypertensive drugs would you avoid with people with dislipidaemia?
diuretics
beta blockers
Which antihypertensive drugs would you avoid with people with HF?
beta blockers
CCB
Which antihypertensive drugs would you avoid with people with asthma/COPD?
ACE inhibitors
Beta blockers
Which antihypertensive drugs would you avoid with people with Peripheral vascular disease?
Beta blockers
ACE inhibitors
All antagonists
Which antihypertensive drugs would you avoid with people with Renal artery stenosis?
Ace inhibitors
all antagonists
Preferred antihypertensive drugs for pregnancy
Nifedipine, labetalol, hydralazine, betablcokers, methyldopa,prazosin
Preferred antihypertensive drugs for Coronary heart disease
Beta-blockers, ACE inhibitors, Calcium channel blockers
Preferred antihypertensive drugs for Congestive heart failure
Ace inhibitors
beta blockers
SE of diuretics?
SE of beta blockers?
SE of CCB
pedal edema
headache
SE of alpha blockers
postural hypotension
SE of Angiotensin II receptor Blockers
headache dizziness
What is microalbuminuria?
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
What is the significance of microalbuminuria?
considered the earliest detectable stage of diabetic nephropathy
Sign and symtoms of acute, ongoing target organ damage?
Brain (headache, confusion, stroke, agitation, seizure) Eyes (papiloedema) Heart (chest pain, SOB) Kidney (urinalysis, renal function)
Headaches, confuson, agitation and seizure are all features fo what?
hypertensive encephalopathy
What are we looking for in the eyes for emergency hypertension?
papilloedema hypertensive retinopathy haemorrhages
Emergency Hypertension Cardiac signs to look out for?
acute coronary syndrome pulmonary oedema acute left ventricular failure
Emergency Hypertension What to look out for in urinanalysis?
Haematuria
Management for emergency hypertension
gradually lowering BP over 24 hours -10% first hour -Further 5-15% subsequent 23 hours -No more than 25% in first 24 hours
What are there exception to gradually lowering BP over 24 hours for emergency hypertension?
Acute phase of ischaemic stroke Haemorrhagc stroke Acute aortic dissection
What is the risk of dropping the blood pressure too quickly?
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.
What are some neurological emergencies related to hypertension
Ischaemic stroke- may want to lower it for thrombolysis
Haemorrhagic stroke- risk vs benefit
head injury
Hypertensive encephalopathy
What are some cardiac emergencies related to hypertension
Heart failure- acute LV dsyfunction and plumonary oedema
ACS
What are some Vascular emergencies related to hypertension
Acute aortic dissection- goal systolic of 100 to 120 mmHg within 20 minutes, HR 60 bpm labetolol
What are some Renal emergencies related to hypertension
Acute hypertensive enphrosclerosis
Haematuria
Elevated creatinine
What are the treatment options for emergency hypertension?
