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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
what does bradykinin do?
mediates inflammation by increasing vascular permeability
26
what are ACEi side effects?
dizziness orthostatic hypotension dry cough GI distress acute kidney injury
27
name some examples of ACEi
ramipril enalapril lisnopril peridopril
28
what are rare ACEi side effects?
angioedema - swelling of deeper tissues swelling out mouth, lips, throat
29
what is conditions should you not take with ACEi
bilateral or renal stenosis hyperkalaemia hypotension
30
what is the function of ARB?
block receptor preventing angiotensin II actions
31
what are the differences between ACEi and ARB?
if ACEi can not be tolerated use ARB ARB do not effect bradykinin
32
name examples of ARB drugs
cardesartan ibesartan iosartan
33
what are the side effects of ARB?
headache dizziness fainitng resp symptoms GI disturbances leg swelling
34
what is the function of CCB?
interfere with the displacement of ca2+ ions through cell membranes
35
what does effect does cCCB have?
peripheral vasodilation coronary vasodilation reduced rate and force of contractibility
36
what are the two classes of CCB drugs?
dihydropyridines and non -dihydropyridines
37
what do dihydropyridines do?
predominantly affect vascular smooth muscle causing vasodilation
38
name some dihydropyridine drugs (CCB)
nifedipine, amlodipine, felodipine (FAN)
39
what does non-dihydropyridines do?
slow heart rate down and affect myocardial tissue
40
name some examples of non-dihydropyridines (CCB)
verapamil, diltiazem
41
what are the side effects of CCB drugs?
ankle swelling flushing dizziness - tend to disappear in a few days constipation bradycardia
42
what are the functions of thiazide type diuretics?
inhibit sodium and water reabsorption
43
name some examples of thiazide type diuretics
Bendroflumethiazide indapamide
44
what are the side effects of thiazide like diuretics
dizziness GI disturbances need to pass urine more often
45
what is the function of beta blockers?
act on heart to reduce CO - competes with noradrenaline act on kidney to reduce renin secretion
46
name some examples of beta blockers
atenolol carvedilol metoprolol
47
what are side effects of beta blockers?
fatigue cold extremities
48
why do you not give beta blockers to asthmatics?
bronchospasms likely
49
what is first line of drugs to over 55, african- origin
CCB
50
what is first line of drugs to non-african origin and under 55?
ACEi or ARB
51
if ACEi/ ARB or CCB doesnt work, what is next line of drugs?
thiazide like diuretics
52
what if ARB/ ACEi + CCB + thiazide like diuretics are not managing BP
specialist advice add spironolactone, B blocker, a blocker
53
what is an early warning sign of HP in males?
erectile dysfunction
54
what should ARBs and ACEi not be given with as it gives nephrotoxicity?
NSAIDs
55
what drugs do you not give withCCB it can cause cardiac depression?
b blockers
56
if a patient has diabetes or gout which medication should they not have to treat HP?
thiazide like diuretics
57
which non-dihydropyridine drug is a phenylalmines?
verapamil
58
Name an example of a statin
atrovastatin
59
how does statins work?
reduce the production of LDL- cholesterol in the liver - less likely to get atherosclerotic plaques
60
what are common side effects of statins
diarrhoea headache nausea
61
what do statins interact with?
grapefruit

Cardiovascular (14 decks)

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