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1ST YEAR SYSTEMS: Cardiovascular > Hypertension treatment > Flashcards

Hypertension treatment Flashcards

1
Q

what methods can be used to identify true hypertension during ‘out of hours’

A

must use ABPM - ambulatory blood pressure monitoring - 24/48 hours - measures as you are moving around, living your life normally, have device on you

or HBPM - home blood pressure monitoring - 1 week of measurements

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2
Q

NICE definition of stage 1 hypertension

A

Clinic blood pressure is 140/90 mmHg or higher

ABPM daytime average 135/85 mmHg or higher

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3
Q

NICE definition of stage 2 hypertension

A

Clinic blood pressure is 160/100 mmHg or higher

ABPM daytime average 150/95 mmHg or higher

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4
Q

NICE definition of severe hypertension

A

Clinic systolic blood pressure is 180 mmHg or higher or diastolic blood pressure is 110 mmHg or higher.

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5
Q

Risk factors contributing to hyperstension (7)

A 
Previous MI, stroke, IHD / Family history
(heart disease)
Smoking
Diabetes mellitus
Hypercholesterolaemia
Renal disease
Male
Age
LV hypertrophy
Alcohol
Race
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6
Q

define end organ damage

A

damage occurring in major organs fed by the circulatory system

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7
Q

Left ventricular hypertrophy LVH

A

enlargement and thickening of the walls left ventricle

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8
Q

what investigations can be done to look for LVH

A

ECG - electrocardiogram

Echocardiogram

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9
Q

What is ACR? and what does it assess

A

Urine albumin to creatinine ratio ACR

kidney disease

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10
Q

Alongwith ACR what else can be used to assess kindey damage

A

renal ultrasound

eGFR - Glomerular Filtration Rate

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11
Q

In general, what treatable causes are screened for with BP measurement? (4)

A

Renal artery stenosis - narrowing of one of the renal arteries

Cushings disease - benign tumor called an adenoma forms in the pituitary gland

Conn’s syndrome - excess production of the hormone aldosterone from the adrenal glands, resulting in low renin levels

sleep apnoea

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12
Q

what is used to assess risk correctly

A

assign risk calculator/ Q-risk

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13
Q

when should treatment of hypertension be started

A

at an overall CVD risk of 20% /10 years

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14
Q

why do we treat hypertension? (2)

A

reduce cerebrovascular disease by 40-50%

reduce MI by 16-30% (heart attack)

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15
Q

How do we treat hypertension?

A

stepped approach
use low doses of several drugs
This approach minimises adverse events and maximises patient compliance

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16
Q

describe the ‘stepped approach’ for treatment of hypertension

A

Do not continuously change antihypertensive medication

Instead add new medication to current therapy until the target BP is achieved

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17
Q

what do BHS guidelines suggest for treatment of a young person with high renin

A

ACE Inhibitor/ARB

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18
Q

what is renin?

A

Renin converts angiotensinogen, which is produced in the liver, to the hormone angiotensin I. An enzyme known as ACE or angiotensin-converting enzyme found in the lungs metabolises angiotensin I into angiotensin II.

Angiotensin II causes blood vessels to constrict and blood pressure to increase.

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19
Q

what do BHS guidelines suggest for treatment of an elderly person with low
renin

A

Calcium Channel Blocker

Thiazide –Type Diuretic

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20
Q

treatment of stage 1 hypertension

A

Offer antihypertensive drug treatment to people aged under 80 years with >140/90 with one or more of the following:

  • target organ damage
  • established cardiovascular disease
  • renal disease
  • diabetes
  • a 10-year cardiovascular risk equivalent to 20% or greater.
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21
Q

treatment of stage 2 hypertension

A

ABPM> 150/95

Offer antihypertensive drug treatment to people of any age with stage 2 hypertension.

22
Q

what do you do with a patient under the age of 40 with stage 1 hypertension or greater?

A

get more detailed assessment of potential target organ damage

specialist evaluation of secondary causes of hypertension

23
Q

what do you do with a patient over the age of 80 with stage 1 hypertension or greater?

A

Offer the same antihypertensive drug treatment as people aged 55–80 years, taking into account any co-morbidities.

Blood Pressure target is different
<145/85

24
Q

what is the white coat effect? what should you consider for these individuals

A

when someone’s blood pressure is higher in medical setting than at home
Consider ABPM or HBPM as an adjunct to clinic blood pressure measurements to monitor response to treatment etc

25
Q

when would a calcium - channel blocker not be a suitable treatment option

A

if patient has oedema or intolerance

if there is evidence of heart failure or a high risk of heart failure

26
Q

what would you offer if patient couldn’t have calcium channel blocker drug

A

thiazide-like diuretic

27
Q

step 1 hypertensive treatment for people aged >55 and to black people of African or Caribbean origin of any year

A

calcium-channel blocker CCB

or thiazide diuretic

28
Q

step 1 treatment if under 55

A

angiotensin converting enzyme inhibitors ACEI/ARB

29
Q

who can’t have angiotensin converting enzyme inhibitors

A

afro-caribbean people

women of child baring age

30
Q

step 2 treatment

A

add thiazide-type diuretic such as clortalidone or indapamide to the CCB or ACEI/ARB

31
Q

step 3 treatment

A

add CCB, ACEI, Diuretic together

32
Q

step 4 treamtent

A

consider further diuretic therapy

be cautious of people with reduced estimated GFR due to risk of hyperkalaemia

consider higher dose thiaizde-like diuretic treatment if blood potassium level is higher than 4.5mmol/L

33
Q

general summary of treatment of hypertension

A

If there are no contraindications start treatment according to age and other pathology

If over 55 years
a calcium channel blocker or diuretic
If young
An ACEI of ARB

if a single agent doesn’t control BP
Then use combination

34
Q

Angiotensin Converting Enzyme Inhibitors

A

Competitively inhibit the actions of angiotensin converting enzyme (ACE)

RAMIPRIL, Perindopril

35
Q

contraindications (reasons they shouldn’t take it) with treatment of hypertension (3)

A

Renal artery stenosis
Renal failure
Hyperkalaemia

36
Q

Adverse drug reactions (5)

A 
cough
first dose hypotension
taste disturbance
renal impairment
angioneurotic oedema
37
Q

what drug-drug interactions occur with hypertensive drugs (3)

A

NSAIDs- precipitate acute renal failure by increasing BP too much

potassium supplements - hyperkalaemia - can cause abnormal heart rhythms

potassium sparing diuretics - hyperkalaemia

38
Q

Angiotensin II Antagonists (ARB)

A

angiotensin II antagonists competitively block the actions of angiotensin II at the angiotensin AT1 receptor

39
Q

examples of calcium channel blockers (2)

A

vasodilator - amlodipine/Felodipine

rate limiting - verapamil/diltiazem

40
Q

how do calcium channel blockers work?

A

blocking the L type calcium channels

selectivity between vascular and cardiac L type channels
relaxing large and small arteries and reducing peripheral resistance
reducing cardiac output

41
Q

Benefits (2), contraindications (3), adverse drug reactions (4) with CCBs

A
  • Benefit in the elderly patient with systolic
    Hypertension
  • Rarely cause postural hypotension

contraindications- Acute MI, Heart failure, bradycardia (rate limiting CCBs)

adverse drug reactions - 
Flushing
Headache
Ankle oedema - vasodilation of smaller peripheral vessels - discontinuation of capillaries - fluid seeps through gaps 
Indigestion and reflux oesophagitis
42
Q

contraindications of thiazide-type diuretics (2)

A

Adverse drug reactions are not common but include gout and impotence (no effect)

43
Q

less commonly used agents

A

centrally acting agent - methyldopa

alpha-adrenoceptor antagonist - doxazosin

44
Q

methyldopa:- use, action, ADRs

A

Main use is in the treatment of hypertension of pregnancy

Converted to alpha-methylnoradrenaline which acts on CNS alpha- adrenoceptors which decrease central sympathetic outflow

Adverse Drug reactions
Sedation and drowsiness
Dry mouth and nasal congestion
Orthostatic hypotension

45
Q

hypertension during pregnancy

A

second most common cause of maternal and fetal death

during norm pregnancy blood pressure falls

46
Q

commonest causes of hypertension by age:-
newborn infants
infants

A 
Newborn infants:- 
Renal artery thrombosis
Renal artery stenosis
Congenital renal malformations
Coarctation
Infants – 6 years:- 
Renal parenchymal disease
Coarctation
Renal artery stenosis
primary hypertension
47
Q

hypertensive emergencies

A

Reduce mean arterial pressure by less than or equal to 25%

Patients with a hypertensive emergency are best managed with a continuous infusion of a short acting, titratable antihypertensive agent.

48
Q

which type of drug delivery should not be used for hypertensive medication

A

sublingual and intramuscular

intermittent as required therapy, oral or IV

49
Q

signs of hypertension

A

elevated BP

retina vascular changes

50
Q

Pulmonary hypertension

A

arterial pressure >35 mmHg at rest

RF - family history, HIV, smoking

Signs - left parasternal heave, loud P2 sound, peripheral/pulm oedema

symptoms - SOB, fatigue, weakness, angina, syncope

Diagnosis/investigation - CXR, ECG, Echo, cMRI, routine bloods, liver ultrasound

Management - exercise, avoid pregnancy - high mortality, O2 during plane travel, flu vaccine, diuretics, anticoagulants

1ST YEAR SYSTEMS: Cardiovascular (39 decks)

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