L97- Introduction to the management of hypertension Flashcards
what are the 8 drugs groups are used to treat hypertension?
- Diuretics
- Angiotensin converting enzyme inhibitors (ACEI’s)
- Angiotensin-II receptor antagonists (ARBs)
- Calcium channel blockers (CCB
- Beta-blockers
- Alpha- blockers
- Centrally acting agents
- Renin inhibitors
what 7 factors affect the choice of drug used to treat hypertension?
- cost
- side effects
- ability to reduce bp
- adherence
- ability to reduce complications
- patient characteristics
- other medical conditions
how does “reduce complication” affect what drugs a patient trying to reduce bp will take?
-reduce myocardial infarction, stroke, heart failure
how does “patient characteristics” affect what drugs a patient trying to reduce bp will take?
- age
- ethnicity
- pregnancy
- allergies
how does “other medical conditions” affect what drugs a patient trying to reduce bp will take?
- specific drug for HT may have added benefits for other diseases e.g. diabetes
- Drug of choice for HT may be contraindicated e.g. asthma
how does “side effects” affect what drugs a patient trying to reduce bp will take?
- some are predictable
- some are unpredictable
- some may cause problems in high risk patients
how does “adherence” affect what drugs a patient trying to reduce bp will take?
- -dose frequency, better once a day
- side effect profile e.g urinary frequency with diuretics
what does “cost” affect what drugs a patient trying to reduce bp will take?
- where its a generic name or branded
- if its a new drug or not
what percentage of people have to take more than one HT drug?
75%
why is using combines drugs to treat HT alright?
they have different pharmacology/mechanisms of action/act on different pathways
what drug groups are used to treat HT?
- calcium channel blockers
- Angiotensin converting enzyme inhibitors (ACEIs)
- Diuretics
- Angiotensin II receptor blockers (ARBs)
- Beta-blockers
- alpha-blockers
- renin inhibitors
- centrally acting agents
what group of people will be given Angiotensin converting enzyme inhibitors (ACEIs)?
- e.g ramipril-first line in all patients who are diabetics, also prevents renal disease caused by diabetes
- first line in patients under 55 years.
- can cause a dry cough
what patients are given diuretics to treat HT?
thiazides- used in combination with other
antihypertensives (Step 2 & 3 NICE 2019) and lower potassium levels
Aldosterone antagonists- first line to treat heart failure
what group of patients would use beta-blockers? example
example atenolol
- NOT asthmatics
- first line for people who are pregnant
- used to treat heart failure
what group of patients would use centrally acting agents?
pregnant women
what are some facts and an example about renin inhibitors?
example= aliskirin
- evidence about them is limited
- they are expensive
- used for patients that are resistant HT
what are some facts and an example about centrally acting agents?
example= methyldopa and clonidine
- reserved for resistant HT
- significant side effects
- methyldopa used in pregnancy
what group of patients will be given calcium channel blockers as first line?
patients over 55 years old and black African Caribbean patients of any age
what are the two types of diuretics?
- thiazides
- aldosterone antagonists
what are some facts about he two different types of diuretics?
- thiazides- can cause low potassium levels and doesn’t work with patients who have had renal failure
- aldosterone antagonists-can cause high potassium levels and used to treat heart failure
what are Angiotensin II receptor blockers (ARBs) and give an example?
losartan- Alternative to ACEIs (especially when
patients develop dry cough)
