Management of Hypertension Flashcards
what is defined as hypertension?
above 140 systolic and 90 for diastolic
what increases the risk of hypertension?
excessive alcohol consumption
overweight
lack of exercise
too much salt
smoking
what are increased risk factors for secondary hypertension?
abnormal kidney production of hormones in adrenal glands
kidney disease
diabetes
some medications
what medications put you at risk of secondary hypertension?
oral contraceptives, herbal meds, corticosteroids
what percentage of people with T2DM have hypertension?
40-50%
what are the biggest risks of hypertension?
heart attack and failure
stroke
narrowing of vessels within kidneys
atherosclerosis
what is the aim of anti-hypertensive drugs?
lower BP at minimal dosages, as few times to take them, fewer medications minimal side effects
what %reduction in risk of major CV event with 10mmHg decrease in BP?
20% reduction
how much is risk of mortality is decreased with decrease in 10mmHg of BP?
13% decrease
which anti-hypertensive medications have biggest effect on reducing risk of a stroke?
CCB
which anti-hypertensive drug type is most likely to reduce risk of heart failure?
thiazide-like diuretics
what BP is classed as stage 1 HP?
> 140/90 - clinic
≥ 135/85 – ABPM, HBPM
what BP are classed as stage 2 HP?
- ≥ 160/100 – clinic
- ≥ 150/95 – ABPM, HBPM
what BP is classed as stage 3 BP?
- ≥ 180/110
when to use ABPM?
- Use if white coat suspected
- Borderline cases
- Apparently treatment is resistant
what values do you use for ABPM?
daytime values for decision to treat
when do you investigate for secondary HP?
if patient is under 40
suspicion of underlying cause
name some signs of end organ damage/ complications
neuro - stroke
heart failure/ arrhythmias
papilledema
who needs treatment in stage 1 HP?
under 80
signs of end organ damage (CVS/ renal)
diabetics
anyone with Qrisk≥ 20%
who needs treatment with stage 2/ 3 HP?
everyone
what is target BP for those with essential hypertension without end -organ damage?
- ≥ 80 years 150/90 or ABPM 145/85
- <80 years 140/90 or ABPM 138/85
what is target BP for those with essential HP and diabetes/renal disease/ end-organ damage
- 130/80 or ABPM 125/85
what is lifestyle advice to be given to those with HP?
BMI to be 18.5- 24.9 kg/m²,
dietary advice,
no more than 14 units a week of alcohol,
reduce salt,
exercise should be daily and enjoyable part of the day.
what is the function of ACEi?
- Inhibit conversion of angiotensin I into II
- Reduce release of aldosterone (aldosterone causes fluid and water retention – stimulates reabsorption of salt and water in the kidneys)
- aid in arterial and left ventricular remodelling
what does bradykinin do?
mediates inflammation by increasing vascular permeability
what are ACEi side effects?
dizziness
orthostatic hypotension
dry cough
GI distress
acute kidney injury
name some examples of ACEi
ramipril
enalapril
lisnopril
peridopril
what are rare ACEi side effects?
angioedema - swelling of deeper tissues
swelling out mouth, lips, throat
what is conditions should you not take with ACEi
bilateral or renal stenosis
hyperkalaemia
hypotension
what is the function of ARB?
block receptor preventing angiotensin II actions
what are the differences between ACEi and ARB?
if ACEi can not be tolerated use ARB
ARB do not effect bradykinin
name examples of ARB drugs
cardesartan
ibesartan
iosartan
what are the side effects of ARB?
headache
dizziness
fainitng
resp symptoms
GI disturbances
leg swelling
what is the function of CCB?
interfere with the displacement of ca2+ ions through cell membranes
what does effect does cCCB have?
peripheral vasodilation
coronary vasodilation
reduced rate and force of contractibility
what are the two classes of CCB drugs?
dihydropyridines and non -dihydropyridines
what do dihydropyridines do?
predominantly affect vascular smooth muscle causing vasodilation
name some dihydropyridine drugs (CCB)
nifedipine, amlodipine, felodipine (FAN)
what does non-dihydropyridines do?
slow heart rate down and affect myocardial tissue
name some examples of non-dihydropyridines (CCB)
verapamil, diltiazem
what are the side effects of CCB drugs?
ankle swelling
flushing
dizziness - tend to disappear in a few days
constipation
bradycardia
what are the functions of thiazide type diuretics?
inhibit sodium and water reabsorption
name some examples of thiazide type diuretics
Bendroflumethiazide
indapamide
what are the side effects of thiazide like diuretics
dizziness
GI disturbances
need to pass urine more often
what is the function of beta blockers?
act on heart to reduce CO - competes with noradrenaline
act on kidney to reduce renin secretion
name some examples of beta blockers
atenolol
carvedilol
metoprolol
what are side effects of beta blockers?
fatigue
cold extremities
why do you not give beta blockers to asthmatics?
bronchospasms likely
what is first line of drugs to over 55, african- origin
CCB
what is first line of drugs to non-african origin and under 55?
ACEi or ARB
if ACEi/ ARB or CCB doesnt work, what is next line of drugs?
thiazide like diuretics
what if ARB/ ACEi + CCB + thiazide like diuretics are not managing BP
specialist advice
add spironolactone, B blocker, a blocker
what is an early warning sign of HP in males?
erectile dysfunction
what should ARBs and ACEi not be given with as it gives nephrotoxicity?
NSAIDs
what drugs do you not give withCCB it can cause cardiac depression?
b blockers
if a patient has diabetes or gout which medication should they not have to treat HP?
thiazide like diuretics
which non-dihydropyridine drug is a phenylalmines?
verapamil
Name an example of a statin
atrovastatin
how does statins work?
reduce the production of LDL- cholesterol in the liver
- less likely to get atherosclerotic plaques
what are common side effects of statins
diarrhoea
headache
nausea
what do statins interact with?
grapefruit
