Introduction to the Management of Hypertension Flashcards
How do you decide which class of hypertensive drugs to use first?
When somebody is first diagnosed with hypertension there is a number of factors to consider when choosing which drug to prescribe.
What is the 3As and COSP?
They stand for the factors which affect which choice of drug is used?
3As:
Ability to reduce b.p
Ability to reduce complications
Adherence
COSP:
Cost
Other conditions
Side effects
Patient characteristics
Why is it important to consider the drug’s ability to reduce complications?
Hypertension does not have a significant impact on an individuals’ life. However living with hypertension significantly impacts the risk of cardiovascular disease such as myocardial infarction and cerebrovascular accident. Not all hypertensive drugs have been clinically proved to lower incident rate of complications.
Which drugs are clinically proved to reduce hypertension complications? (ABCD)
Angiotensin II converting enzyme inhibitors: ACEIs
Beta blockers
Calcium channel blockers
Diuretics
How does age impact choice of hypertensive drugs?
As you got older, production of renin decreases. Any hypertensive drugs that target renin production as a method to control blood pressure is not appropriate for the elderly.
Which drugs would not be appropriate for people of black African and Caribbean ethnicity?
Again people of this ethnicity produce less renin, would not use drugs that target renin.
Also they appear to present greater side effects of ACE inhibitors.
NO ACE inhibitors or ARBs
Which groups of patients are more likely to experience the side effects of hypertensive medication?
The elderly
Those with renal impairment
What factors will impact patient’s adherence to the medication?
The inconvenience of the side effects (increased urination with diuretics).
The frequency of the medication (if people have to take medication three times a day they are less likely to adhere in comparison to just once a day).
How can hypertensive drugs be used with other medical conditions?
Treatment for another condition may have a side effect of lowering blood pressure (would not require an additional b.p drug).
Specific drug for HT may have added benefits (diuretics prevent kidney failure).
Certain drugs may be contraindicated (can’t use beta blockers for renal disease).
When are combinations of hypertensive drugs used?
Essentially when the target blood pressure is not reached with optimized monotherapy. This is when even with the highest possible dose of the drug, it is not lowering blood pressure enough.
What are the target blood pressures?
Younger than 80:
Less than 140/90
Older than 80:
Less than 150/90
If you are type 1 diabetic:
Less than 140/80
If you have established CVD/ Renal impairment:
Less than 130/80
What is the percentage of hypertension patients that require multiple HT drugs?
75%; first 4 weeks must be on a single drug
What must be considered when combining drugs?
The drugs must have different pharmacology; mechanism in which they work. Avoid using drugs that have the same side effects. Assess flowchart (advises which drugs to use first).
When are Calcium channel blockers the first HT drug used?
If you are older than 55
If you are Black African Caribbean ethnicity of any age
These do not act on the Renin-Angiotensin system so are useful for the two demographics that have lower renin production
What are examples of Calcium Channel blockers?
Amlodipine and diltiazem
