Hypertension Therapy Flashcards
in stage 1 hypertension what is clinical blood pressure
140/90 mmHg or higher
in stage 1 hypertension what is ABPM daytime average
135/85mmHg or higher
in stage 2 hypertension what is clinical blood pressure
160/100mmHg or higher
in stage 2 hypertension what is ABPM daytime average
150/95mmHg or higher
what is renal artery stenosis most often caused by
atherosclerosis or fibromuscular dysplasis
what is Fibromuscular dysplasia
a disease of the blood vessels that causes abnormal growth within the artery wall
why do we treat hypertension
reduce cerebrovascular disease by 40-50%
reduce MI by 16-30%
how do we treat hypertension
stepped approach use of low doses of several drugs
what age group would receive an ACE inhibitor/ARB as part of treatment for hypertension
under 55 years old
what age group would receive Calcium Channel Blocker and Thiazide –Type Diuretic
over 55 years old
what are the two Angiotensin converting enzyme inhibitors
Ramipril
Perindopril
what does ACE convert Angiotensin I to
active angiotensin II
what does Angiotensin II do to blood vessels
Angiotensin II is a potent vasoconstrictor
also a hypertrophic agent
what is the function of aldosterone
- increases Na+ re-absorption
- increases the release of ADH from the pituritary
- vasoconstrictor
what are contraindications that may prevent you from giving a patient ACE inhibitors
renal artery stenosis
renal failure
hyperkalemia
what drug that you know of precipitates acute renal failure
NSAIDs
what is an example of a Angiotensin II Antagonist (ARB)
Losartan
what happens to blood vessels as a result of taking Angiotensin II Antagonists
they block the action of angiotensin II binding to the receptors on the muscles surrounding blood vessels. As a result blood vessels dilate and blood pressure is reduced
are calcium channel blockers vasodilaters or vasoconstrictors
vasodilaters
what are two examples of calcium channel blockers
Amlodipine/Felodipine
what type of calcium channels do CCBs block
L type calcium channels
if a patient is over 55 years and in need of a antihyperintensive, what would you give them
a CCB
if a women of child bearing age needed an anti hypertensive, what would you give her
a CCB
what are two Thiazide type diuretics that you know of
Indapamide, Clortalidone
what is commonly the first line of treatment for afro-caribbean individuals with mild-moderate hypertension
Thiazide-type diuretic
what is the effect of Thiazide type diuretics
make kidneys pass out more water
dilate blood vessels
these two effects reduce blood pressure
what is the function of Alpha-adrenoceptor antagonists
block the effect of the sympathetic nerves on blood vessels by binding to alpha-adrenoceptors located on vascular smooth muscle.
name a alpha-adrenoceptor antagonist
Doxazosin
what is the function of Centrally acting agents in the treatment of hypertension
lower heart rate
reduce blood pressure
they do this by preventing your brain from sending signals to your nervous system to speed up your heart rate and narrow your vessels
what are some adverse drug reactions of Alpha-adrenoceptor antagonists
first dose hypotension
dizziness
dry mouth
headache
in hypertension treatment what group of patients will centrally acting agents mainly be used as treatment
treatment of hypertension on pregnant women
what is a common risk factor for preeclampsia
existing primary hypertension
what is esmolol
cardioselective beta 1 receptor
what is stage 1 hypertension in children defined as
Defined as BPs from the 95th-99th percentile plus 5mmHg.
what is stage 2 hypertension in children defined as
BP above the 99th percentile plus 5mmHg
what are the commonest causes of hypertension i newborn infants
Renal artery thrombosis
Renal artery stenosis
Congenital renal malformations
Coarctation
what is coarctation
congenital narrowing of a short section of the aorta
what are the commonest causes of hypertension in infants - 6 years
Renal parenchymal disease
Coarctation
Renal artery stenosis
what are the commonest causes of hypertension in children 6-10 years
renal parenchymal disease
renal artery stenosis
primary hypertension
what are the commomest causes of hypertension in adolescents aged 10-18
primary hypertension
renal parenchymal disease
what is accelerated hypertension
Increase in blood pressure to levels ≥180 mm Hg systolic and ≥110 mm Hg diastolic, resulting in target organ damage
what is the definition of hypertensive urgency
sever hypertension with no evidence of target organ damage
what is a common cause a accelerated hypertension
non adherence to medication
how many “what not to do!” treatment guidelines are there
6 * see slide 90 of hypertension therapy
how are patents with a hypertensive emergency best managed
a continuous infusion of a short acting, titratable antihypertensive agent
during a hypertensive emergency what type of drug administration should be avoided at all time
sublingual
intramuscular
in accelerated hypertension what is the aim of treatment in the first hour
The immediate goal is to reduce DBP by 15–20% or to about 110mmHg over a period of 30–60 min
what are treatable causes of hypertension that can be screened for
renal artery stenosis
cushings disease
Conns syndrome
sleep apnoea
