pharmacological treatment of hypertension Flashcards
what are three different ways of calculating cardiovascular risk?
ASSIGN
Qrisk
JBS3
when would anti-hypertensive drugs be indicated with stage 1 hypertension?
if the patient is younger than 40 if there is target organ damage 10-year cardiovascular is greater than 20% diabetes renal disease
what are the three main goals of anti-hypertensive treatment?
- reduce arterial blood pressure to recommended targets
- reduce risk of end organ damage (cardiovascular, renal, cerebrovascular)
what is the target blood pressure for patients aged over 80?
less than 150/90 mmHg
what is the target blood pressure for standard patients?
less than 140/90
what is the target blood pressure for patients with cardiac or renal disease or diabetes?
less than 130/80
what is the first step if the patient is under 55 years old and of caucasian origin?
A - ACE inhibitor or low cost angiotensin 2 receptor blocker (ARB)
what is the first step of treatment if the patient is over 55, black or of afro-carribean origin?
C - calcium channel blocker
what is the second step of treatment for all patients?
add either A (ACE inhibitor or ARB) or C (calcium channel blocker)
what is the third step of treatment for all patients?
D - thiazide like diuretic
what is the final step of treatment for RESISTANT HYPERTENSION?
consider further diuretic (spirolone or furosemide for patients with moderate-severe renal impairment)
alpha or beta blocker
what are the two main types of angiotensin converting enzyme inhibitors?
ramipril and lisinopril
what is a the one ARB?
Iosartan
what are the three dihydropyridine derived calcium channel blockers?
amlodipine
lercanidipine
felodipine
what are the two thiazide-like diuretics?
indapamide
bendroflumethiazide
what is the aldosterone antagonist diuretic?
spironolactone
where about in the kidney nephron do thiazine-like diuretics prevent sodium reabsorption?
in the distal tubule
where about do the aldosterone antagonist diuretics prevent sodium reabsorption?
in the collecting duct
what are some advantages of multi drug treatment?
- each drug is working at a different site in the body
- reduces dose burden
what are some disadvantages of multi drug treatment?
side-effects may be more frequent
increased drug cost to NHS
