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cardiovascular > Management of Hypertension > Flashcards

Management of Hypertension Flashcards

1
Q

what is defined as hypertension?

A

above 140 systolic and 90 for diastolic

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2
Q

what increases the risk of hypertension?

A

excessive alcohol consumption
overweight
lack of exercise
too much salt
smoking

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3
Q

what are increased risk factors for secondary hypertension?

A

abnormal kidney production of hormones in adrenal glands
kidney disease
diabetes
some medications

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4
Q

what medications put you at risk of secondary hypertension?

A

oral contraceptives, herbal meds, corticosteroids

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5
Q

what percentage of people with T2DM have hypertension?

A

40-50%

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6
Q

what are the biggest risks of hypertension?

A

heart attack and failure
stroke
narrowing of vessels within kidneys
atherosclerosis

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7
Q

what is the aim of anti-hypertensive drugs?

A

lower BP at minimal dosages, as few times to take them, fewer medications minimal side effects

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8
Q

what %reduction in risk of major CV event with 10mmHg decrease in BP?

A

20% reduction

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9
Q

how much is risk of mortality is decreased with decrease in 10mmHg of BP?

A

13% decrease

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10
Q

which anti-hypertensive medications have biggest effect on reducing risk of a stroke?

A

CCB

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11
Q

which anti-hypertensive drug type is most likely to reduce risk of heart failure?

A

thiazide-like diuretics

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12
Q

what BP is classed as stage 1 HP?

A

> 140/90 - clinic
≥ 135/85 – ABPM, HBPM

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13
Q

what BP are classed as stage 2 HP?

A
  • ≥ 160/100 – clinic
  • ≥ 150/95 – ABPM, HBPM
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14
Q

what BP is classed as stage 3 BP?

A
  • ≥ 180/110
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15
Q

when to use ABPM?

A
  • Use if white coat suspected
  • Borderline cases
  • Apparently treatment is resistant
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16
Q

what values do you use for ABPM?

A

daytime values for decision to treat

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17
Q

when do you investigate for secondary HP?

A

if patient is under 40
suspicion of underlying cause

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18
Q

name some signs of end organ damage/ complications

A

neuro - stroke
heart failure/ arrhythmias
papilledema

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19
Q

who needs treatment in stage 1 HP?

A

under 80
signs of end organ damage (CVS/ renal)
diabetics
anyone with Qrisk≥ 20%

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20
Q

who needs treatment with stage 2/ 3 HP?

A

everyone

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21
Q

what is target BP for those with essential hypertension without end -organ damage?

A
  • ≥ 80 years 150/90 or ABPM 145/85
  • <80 years 140/90 or ABPM 138/85
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22
Q

what is target BP for those with essential HP and diabetes/renal disease/ end-organ damage

A
  • 130/80 or ABPM 125/85
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23
Q

what is lifestyle advice to be given to those with HP?

A

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.

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24
Q

what is the function of ACEi?

A
  • 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
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25
Q

what does bradykinin do?

A

mediates inflammation by increasing vascular permeability

26
Q

what are ACEi side effects?

A

dizziness
orthostatic hypotension
dry cough
GI distress
acute kidney injury

27
Q

name some examples of ACEi

A

ramipril
enalapril
lisnopril
peridopril

28
Q

what are rare ACEi side effects?

A

angioedema - swelling of deeper tissues
swelling out mouth, lips, throat

29
Q

what is conditions should you not take with ACEi

A

bilateral or renal stenosis
hyperkalaemia
hypotension

30
Q

what is the function of ARB?

A

block receptor preventing angiotensin II actions

31
Q

what are the differences between ACEi and ARB?

A

if ACEi can not be tolerated use ARB
ARB do not effect bradykinin

32
Q

name examples of ARB drugs

A

cardesartan
ibesartan
iosartan

33
Q

what are the side effects of ARB?

A

headache
dizziness
fainitng
resp symptoms
GI disturbances
leg swelling

34
Q

what is the function of CCB?

A

interfere with the displacement of ca2+ ions through cell membranes

35
Q

what does effect does cCCB have?

A

peripheral vasodilation
coronary vasodilation
reduced rate and force of contractibility

36
Q

what are the two classes of CCB drugs?

A

dihydropyridines and non -dihydropyridines

37
Q

what do dihydropyridines do?

A

predominantly affect vascular smooth muscle causing vasodilation

38
Q

name some dihydropyridine drugs (CCB)

A

nifedipine, amlodipine, felodipine (FAN)

39
Q

what does non-dihydropyridines do?

A

slow heart rate down and affect myocardial tissue

40
Q

name some examples of non-dihydropyridines (CCB)

A

verapamil, diltiazem

41
Q

what are the side effects of CCB drugs?

A

ankle swelling
flushing
dizziness - tend to disappear in a few days
constipation
bradycardia

42
Q

what are the functions of thiazide type diuretics?

A

inhibit sodium and water reabsorption

43
Q

name some examples of thiazide type diuretics

A

Bendroflumethiazide
indapamide

44
Q

what are the side effects of thiazide like diuretics

A

dizziness
GI disturbances
need to pass urine more often

45
Q

what is the function of beta blockers?

A

act on heart to reduce CO - competes with noradrenaline
act on kidney to reduce renin secretion

46
Q

name some examples of beta blockers

A

atenolol
carvedilol
metoprolol

47
Q

what are side effects of beta blockers?

A

fatigue
cold extremities

48
Q

why do you not give beta blockers to asthmatics?

A

bronchospasms likely

49
Q

what is first line of drugs to over 55, african- origin

A

CCB

50
Q

what is first line of drugs to non-african origin and under 55?

A

ACEi or ARB

51
Q

if ACEi/ ARB or CCB doesnt work, what is next line of drugs?

A

thiazide like diuretics

52
Q

what if ARB/ ACEi + CCB + thiazide like diuretics are not managing BP

A

specialist advice
add spironolactone, B blocker, a blocker

53
Q

what is an early warning sign of HP in males?

A

erectile dysfunction

54
Q

what should ARBs and ACEi not be given with as it gives nephrotoxicity?

A

NSAIDs

55
Q

what drugs do you not give withCCB it can cause cardiac depression?

A

b blockers

56
Q

if a patient has diabetes or gout which medication should they not have to treat HP?

A

thiazide like diuretics

57
Q

which non-dihydropyridine drug is a phenylalmines?

A

verapamil

58
Q

Name an example of a statin

A

atrovastatin

59
Q

how does statins work?

A

reduce the production of LDL- cholesterol in the liver
- less likely to get atherosclerotic plaques

60
Q

what are common side effects of statins

A

diarrhoea
headache
nausea

61
Q

what do statins interact with?

A

grapefruit

cardiovascular (14 decks)

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