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CDL301 > Lectures 9 and 10 Systemic Hypertension > Flashcards

Lectures 9 and 10 Systemic Hypertension Flashcards

1
Q

What are the major risk factors as a result of hypertension (HT)?

A 
stroke (ischaemic and haemorrhagic)
heart failure
chronic renal disease
cognitive decline
premature death 
atrial fibrillation
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2
Q

each 2mmHg rise in systolic blood pressure is associated with:

A

a 7% increase in mortality from IHD

a 10% increase in mortality from stroke

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3
Q

What is the clinical threshold for suspected HT?

How is this confirmed?

A

140/90 mmHg or higher

offered ambulatory blood pressure monitoring (ABPM)

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4
Q

What treatments are essential for primary HT?

A

lifestyle modifications

antihypertensive drugs

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5
Q

What are the considerations for secondary HT?

A

age of patient
resistant blood pressure
symptoms/signs of underlying cause

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6
Q

What are the 3 stages of HT?

A

stage 1 - clinical BP 140/90 and ABPM 135/85
stage 2 - clinical BP 160/11 and ABPM 150/95
severe - clinical BP 180/110

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7
Q

What are the blood pressure targets for over and under the age of 80?

A

under 80 - clinical BP 140/90 and ABPM 135/85

over 80 - clinical BP 150/90 and ABPM 145/85

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8
Q

What is the criteria for anti-HT treatment offered to stage 1s under the age of 80?

A 
one or more of
target organ damage
established cardiovascular disease
renal disease
diabetes
10-year cardiovascular risk of 20% or greater
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9
Q

What are the mechanisms targeted by blood pressure control targets?

A 
cardiac output 
peripheral resistance
renin-angiotensin-aldosterone 
sympathetic nervous system (noradrenaline)
local vascular mediators
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10
Q

What are ACE inhibitors used to treat?

A

hypertension
heart failure
diabetic nephropathy

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11
Q

Give examples of ACE inhibitors (x4)

A

ramipril
perindopril
enalapril
trandolapril

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12
Q

What are Angiotensin II Receptor Blockers (ARB) used to treat?

A

hypertension
diabetic nephropathy
heart failure (when ACE inhibitor contraindicated)

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13
Q

Give examples of ARBs (x5)

A 
candesartan
valsartan
telmisartan
losartan
irbesartan
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14
Q

What are the adverse effects of ARBs?

A 
symptomatic hypotension (volume depletion)
hyperkalaemia
potential for renal dysfunction
rash 
angio-oedema
contraindicated in pregnancy
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15
Q

What are Calcium Channel Blockers (CCBs) used to treat?

A

HT
IHD
angina
arrhythmia

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16
Q

Give examples of CCBs (x6)

What does each treatment target?

A 
amilodipine - HT
nifedipine - HT
diltiazem - IHD, angina and arrhythmias
felopine - HT
lacidipine - HT
verapamil - IHD, angina and arrhythmias
17
Q

What are the 3 types of L-type CCBs?

A

dihydropyridines - HT treating CCBs
phenylalkylamines - verapamil
benzothiazepines - diltiazem

18
Q

What do dihydropyridine CCBs act on?

What are the main adverse effects?

A

vascular smooth muscle and arterial vasodilators

peripheral vasodilation - flushing, headache, oedema, palpitations

19
Q

What do phenylalkylamine CCBs act on?

What are the main adverse effects?

A

heart - negatively chronotropic and inotropic
negative chronotropic - bradycardia and AV block
negative inotropic - worsening of cardiac failure
constipation

20
Q

What do benzothiazepine CCBs act on?

What are the main adverse effects?

A

intermediate heart and peripheral vasculature

negative chronotropic - bradycardia and AV block

21
Q

Give examples of alpha-1 adrenoceptor blockers (x4)

A

doxazosin
terazosin
indoramin
prazosin

22
Q

What is a clinical problem of alpha-1 adrenoceptor blockers?

A

postural hypotension

23
Q

Give examples of centrally acting anti-hypertensives (x3)

What are the mechanisms of action of these drugs?

A

moxonidine - imidazoline type 1 receptor agonist

methyldopa - activates pre-synaptic alpha 2 receptors to decrease NA release and a competitive inhibitor of DOPA decarboxylase - can be used during pregnancy

clonidine - activates pre-synaptic alpha 2 receptors to decrease NA release

24
Q

Give an example of a direct renin inhibitor

A

aliskiren

25
Q

What are the adverse effects renin (RAAS) inhibitors?

A 
hyperkalaemia
dizziness
arthralgia (joint pain)
diarrhoea
concomitant use not recommended
26
Q

What is the treatment steps for HT in someone under 55 years?

A
  1. ACE inhibitor or angiotensin-II blocker
    • CCB
    • thiazide-like diuretic
  4. resistant HT
27
Q

What is the treatment steps for HT in someone over 55 years or afro-Caribbean of any age?

A
  1. CCB
    • ACE-inhibitor or angiotensin-II blocker
    • thiazide-like diuretic
  4. resistant HT
28
Q

What treatments should be considered if a patient presents with resistant HT?

A

spironolactone
high dose thiazide-like diuretic
alpha blocker
beta blocker

CDL301 (14 decks)

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