Hypertension - treatment Flashcards
What is used in step 1 treatment in those aged under 55yo/high renin hypertension?
Angiotensin converting enzyme inhibitors
Angiotensin II antagonists
Suitable for those with high renin hypertension
What is used in step 1 treatment in those over 55yo or of afro-caribbean origin/low renin hypertension?
Calcium channel blockers
Thiazide type diuretics
Suitable for those who have low renin hypertension
Name some ACE inhibitors
Ramipril
Perindopril
When might calcium channel blockers be unsuitable?
Oedema
Intolerance
Evidence or high risk of HF
When might ACEI/ARBs be unsuitable?
Teratogenic - do not use in young women of child bearing age
Describe some contraindications when using ACEIs
Renal artery stenosis
Renal failure
Hyperkalaemia
Whats are some ADRs when using ACEIs?
Cough! First dose hypotension Taste disturbance Renal impairment Angioneurotic oedema
What DDIs must you be wary of when using ACEIs?
NSAIDs
Potassium supplements
Potassium sparing diuretics
Name some angiotensin II antagonists (ARBs)
Valsartan
Losartan
Candesartan
Irbesartan
Give one advantage and one disadvantage when using ARBs over ACEIs
No cough and fewer side effects
Not as effective at preventing secondary MIs and strokes
Give some examples of both rate limiting and vasodilator calcium channel blockers
Vasodilators - amlodipine, felodipine
Rate limiting - verapamil, diltiazem
What do CCBs block?
L-type calcium channels
Name some contraindications when using CCBs
Acute MI
HF
Bradycardia (when using rate limiting)
Name some ADRs to watch out for when using CCBs
Flushing Headache Ankle oedema Indigestion Reflux oesophagitis
Name two side effects specific to rate limiting CCBs
Bradycardia
Constipation
Name some thiazide type diuretics
Indapamide
Clortalidone
Describe briefly the mechanism of action of thiazide type diuretics
Block Na reabsorption, enhancing urinary sodium loss
What are some ADRs associated with thiazide type diuretics?
Gout
Impotence, particularly in men
Name 3 classes of less commonly used anti-hypertensives
Alpha-adrenoreceptor antagonists
Centrally acting agents
Vasodilators
Name an alpha-adrenoreceptor antagonist
Doxazosin
Name some ADRs associated with alpha-adrenoreceptor antagonists
Dry mouth
First dose hypotension
Dizziness
Headaches
Describe the mechanism of action of methyldopa for hypertension
Converted to a-methylnoradrenaline, which acts on CNS a-adrenoceptors to decrease central sympathetic outflow
Describe some ADRs associated with methyldopa
Dry mouth
Nasal congestion
Sedation and drowsiness
Orthostatic hypotension
What type of drug is moxonidine?
Centrally acting imidazoline agonist. These receptors are found in the medulla oblongata, and cause a decrease in sympathetic nervous system activity and, therefore, a decrease in blood pressure.
Roughly how many women with hypertension develop pre-eclampsia when pregnant?
1/3
What proportion of women who develop pre-eclampsia develop CVD events?
1/2
How do we differentiate between gestational hypertension and pre-eclampsia
Gestational hypertension - BP rises but no proteinuria
Pre-eclampsia - BP rises severely from about 20 weeks >140/90mmHg with proteinuria
Define proteinuria
Protein >300mg/24hr
