Hypertention & ACEi Flashcards
Target BP for those under 80
Clinic:
140/90 mmHg
135/85mmHg
Target BP for those with CV disease/high risk
What conditions are included in this?
130/80
Artherosclerotic CV disease, diabetes in presence of kidney, eye or cerebrovascular disease
How long is a new antihypertensive used for to establish response
4 weeks
Define stage 1 hypertension and when should you treat?
Stage 2?
Severe?
Stage 1 - 140/90mmHg - treat those under 80 who have target-organ damage, CV disease, renal disease , diabetes, 10 year risk over 20%
If under 40 and no target organ damage refer.
Stage 2 - 160/100 - treat all
Severe - 180/110 - treat promptly
Treatment steps for patient under 55
ACEi ( if not tolerated ARB or BB) CCB thiazide like diuretic Spironolactone and specialist referral Alpha blocker
Treatments steps for over 55, or black people of any age
CCB ( or if evidence of HF try thiazide like diuretic)
ACEi
Then as with under 55
Who should get low dose aspirin
Only those with establish pec CV disease
Target BP for over 80 years
150/90
Target BP for patients with diabetes
140/80
In T1DM hypertension usually indicates ….
Diabetic nephropathy
ACEi should be considered for all patients with …… (Sign of renal disease)
Proteinuria
Choices for treating hypertension in pregnancy
Labetalol
Mehthyldopa
MR nifedipine
Target of BP for pregnancy
- uncomplicated hypertension
- target organ damage
150/100
140/90
Risk factors for developing preeclampsia 5
Hypertension CKD diabetes Autoimmune disease Hypertension in previous pregnancy
Women at risk of preeclampsia should take… From when…
Aspirin low dose - from week 12 to term
Also applies for those over 40, over 10 years since last pregnancy, BMI over 35, multiple pregnancy, FH
Risks of reducing BP to fast during hypertensive crisis
Reduced organ percussion leading to cerebral infraction, blindness, deterioration in renal function, myocardial ischaemia
what class of drugs may be used to treat phaechromocytoma (tumour of the adrenal gland releasing noadrenaline)
alpha blockers such as phenocybenzaine and phentolamine
what classes of drugs are doxazoxcin and prazosin
alpha blockers (and vasodilators)
what class of drug is hydralazine and why do we not often use it
alphablocker
used as an adjunt in hypertensive treatment but causes tachycardia and fluid retention when used alon
when is methyl dopa used as an antihypertensive
pregnancy
it is a centrally acting antihypertensive
why is clonidine not often used
centrally acting antihypertensive but causes rebound hypertension on withdrawl
what is the mode of action of alfuzosin, terazocin and tamsulosin
what are they used for
alpha blockers for BPH
when starting ACEi what electrolyte discturbance should first be addressed
-stop K supplements and K sparing diuretics as ACEi may cause hyperkalaemia
what is a caution when introducing an ACEi to a patient already taking a high dose of loop diuretic in HF?
what is classed as high dose
profound first dose hypertension
(temporary withdrawl of the loop may reduce risk but conversely cause pulmonary oedema)
furosemide 80mg OD
ACEi have a role in managing what side effect of diabetes
nephropathy
why should ACEi not be given with NSAIDs
increased risk of renal damage
what renal condition should we never used ACEi/ARB in?
renal artery stenosis {bilateral or severe unilateral} (ACEi would reduce glomerular filtration causing failure)
- also caution ACEi in peripheral vascular disease
what to change ACEi to if patient experiences dry cough?
why does this help?
ARB
they don’t inhibit breakdown of bradykinin (bradykinin causes the cough(
why should you not use more than one drug affecting the renin angiotensin system
increased risk of hyperkalaemia, hypotension and renal impairment
why should afro-carribean pt not receive ACEi? (2)
less likely to respond (as likely to have low rennin hypertension)
more likely to develop angioedema
what should you do with ACEi pt develops altered LFTs
stop ACEi - reports of cholestatic jaundice, hepatitis, hepatic necrosis etc.
what time of day should the first dose of ACEi be given
bedtime
what is aliskiren?
renin inhibitor
if someone has HF what antihypertensive are we thinking about first line
thiazide like diuretic
if a pt has a STEMI how fast should there BP be reduced
reduce over period of 2 mins to 2 hours by 20-25%
mode of action of sildenafil
vasodilator
mode of action of iloprost
vasodilator
mode of action of doxasosin
alpha blocker
mode of action of methyldopa
centrally acting
mode of action of guanethidine monosulfate
adrenergic neurone blocker
mode of action of aliskiren
renin inhibitor (so probs dont give with ACE/ARBs!)
how fast do ACEi reduce BP
2 hours
