Hypertension - Treatment Flashcards
What is the first step to diagnose hypertension?
Must use ambulatory blood pressure monitoring (ABPM)
or home blood pressure monitoring (HBPM)
What does ABPM stand for?
Ambulatory blood pressure monitoring
What does HBPM stand for?
Home blood pressure monitoring
What are the different stage of hypertension?
Stage 1
Stage 2
Severe
What is stage 1 hypertension?
Clinic blood pressure of 140/90mmHg
ABOM daytime average of 135/85mmHg
What is stage 2 hypertension?
Clinic blood pressure of 160/100mmHg
ABPM daytime average of 150/95mmHg
What is severe hypertension?
Clinic systolic blood pressure of 180mmHg
or
Diastolic blood pressure os 110mmHg
What is the unit of blood pressure?
mmHg
What 3 things must be done after diagnosing hypertension?
Assess the risk
Assess end organ damage
Screen for treatable causes
What are examples of things that change the risks of having hypertension?
Previous myocardial infarction, stroke ischaemic heart disease
Smoking
Diabetes mellitus
Hypercholesterolemia
Family history
Physical examination
What tests can be done to assess end organ damage?
ECG
Echocardiogram
Proteinuria
Renal ultrasound
Renal function
What are examples of treatable causes of hypertension that can be screened for?
Renal artery stenosis
Cushing’s disease
Conn’s syndrome
Sleep apnoea
How can people check there own risk?
Using online risk calculators
What does the BHS suggest target blood pressure should be?
<135/80-85mmHg
When should treatment for high blood pressure start?
Overall cardiovascular disease risk of 20% in the next 10 years
Why do we treat hypertension?
Reduces cardiovascular disease by 40-50%
Reduces myocardial infarction by 16-30%
By what percentage does treating hypertension reduce risk of cardiovascular disease?
40-50%
By what percentage does treating hypertension reduce risk of myocardial infarction?
16-30%
How do you describe the approach of treating hypertension?
Stepped approach
What does a stepped approach to the treatment of hypertension mean?
Do not continuously change antihypertensive medication
Add new medication to current therapy until the target blood pressure is achieved
How kind of doses and number of drugs are used to treat hypertension?
Low doses of several drugs to minimise adverse effects and maximise patient compliance
What needs to be remembered about all drugs?
They have side effects
How can you describe the renin of young people compared to elderly people?
Young people have high renin whereas elderly have low
What kinds of drugs are recommended for use on young people?
ACE inhibitor
Angiotensin II receptor blockers (ARBS)
What does ARBs stand for?
Angiotensin II receptor blockers
What kind of drugs are recommended for elderly people?
Calcium channel blocker
Thiazide-type diuretic
Should treatment always be offered for stage 1 hypertension?
No, only if they are young than 80 and have at least one of the following:
Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk greater than 20%
When should treatment be offered for stage 1 hypertension?
Young than 80 with at least one of the following:
Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk greater than 20%
Should treatment always be given for stage 2 hypertension?
Yes
Does age impact whether treatment is given for stage 1 hypertension?
Yes, only give treatment if younger than 80
Does age impact whether treatment is given for stage 2 hypertension?
No
What should you do for people younger than 40 with hypertension?
Seek specialist evaluation of secondary causes and a more detailed assessment of potential target organ damage
For what age group is the target blood pressure different?
People over 80
What is the target blood pressure for people over 80?
<145/85mmHg
How can blood pressure be monitored?
Clinic blood pressure measurements
ABPM (ambulatory blood pressure monitoring) or HBPM (home blood pressure monitoring)
How many steps are there in the stepped approach of hypertension treatment?
4
What is step 1 treatment for someone over 55?
Calcium channel blocker (CCB)
If CCB unsuitable use thiazide-like diuretic instead
Who should a calcium channel blocker (CCB) be offered to as step 1 treatment?
People over 55 and black people
Who should an ACE inhibitor not be offered to?
Black people and pregnant woman
Why would a calcium channel blocker (CCB) be unsuitable?
Oedema
Intolerance
What does CCB stand for?
Calcium channel blocker
What is step 2 tratement for hypertension?
Add thiazide-type diuretic such as cloralidone or indapamide to CCB or ACEI/ARB
What should be used for step 1 treatment of hypertension for people younger than 55 who are not black?
ACE inhibitor or angiotensin II receptor blocker (ARBs)
What is step 3 treatment for hypertension?
Add CCB, ACEI and diuretic together
What is step 4 treatment for?
Resistant hypertension
What is given for step 4 treatment of hypertension?
Consider further diuretic therapy with low dose spironolactone (25mg once daily) if the blood potassium level is 4.5mmol/L or lower
Consider higher dose thiazide-like diuretic treatment if the blood potassium level is higher than 4.5mmol/L