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Pharmacology 3001 > Pharmacological treatment of Hypertension > Flashcards

Pharmacological treatment of Hypertension Flashcards

1
Q

What increases the chances of harm of hypertension?

A
  • How high the blood pressure is
  • How long the person has had high blood pressure
  • Whether any relevant concurrent health problems (such as high cholesterol or diabetes)
  • Concordance with meds / lifestyle changes
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2
Q

How does each 2mmHg increase affect the chances of heart disease and stroke?

A
  • 7% from heart disease

- 10% from stroke

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3
Q

What percentage of adults over the age of 16 have any CVD condition?

A

15%

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4
Q

What are the main goals of hypertensive treatment?

A
  • Reduce arterial blood pressure to recommended targets
  • Reduce risk of end organ damage (cardiovascular, renal, cerebrovascular)
  • Reduce risk of mortality due to Cardiovascular disease
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5
Q

With effective hypertensive treatment how much can the risk of coronary heart diseae be reduced?

A

20%

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6
Q

With effective hypertensive treatment how much can the risk of cerebrovascular diseae be reduced?

A

30%

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7
Q

At what blood pressure should blood pressure only be checked every 5 years?

A

when under 140/90 mmHg (ABPM/HBPM under 135/85 mmHg)

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8
Q

When are anti-hypertensive drugs indicated?

A
  1. People of any age with stage 2 or 3 hypertension
  2. People with stage 1 hypertension who have on or more of the following:
    - Target organ damage
    - Established cardiovascular disease (CHD,CVA)
    - Renal disease
    - Diabetes
    - A 10-year CV risk equivalent to 10% or greater
  3. Use clinical judgement for people of any age with frailty or multimorbidity
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9
Q

What are some of the CV risk score calculators called?

A
  • ASSIGN
  • Qrisk
  • JBS3
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10
Q

What are some of the factors that increase CV risk?

A
  • BP
  • Age
  • Weight/height
  • Gender
  • Smoking
  • Cholesterol
  • Ethnicity
  • Social class
  • Family history
  • Diabetes, rheumatoid arthritis, renal function
  • Atrial fibrilation
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11
Q

What is the bp goal for ‘standard’ patients?

A

< 140 / 90 mmHg

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12
Q

What is the bp goal for patients over 80 years old?

A

< 150 / 90 mmHg

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13
Q

What drugs can increase bp?

A
  • NSAIDs
  • Oral steroids
  • Venlafaxine (anti-depressant)
  • Oral sympathomimetic decongestants (e.g Pseudoephedrine - ‘sudafed’)
  • Soluble or dispersible drugs - contain SALT!
  • Illicit drug use
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14
Q

What is the step 1 treatment for a patient with hypertension under the age of 55 and without black ethnicity. Also any patient with both hypertension and type 2 diabetes?

A

ACEi or ARB

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15
Q

What is the step 1 treatment of a patient with hypertension without type 2 diabetes who is over 55 (or of any age but is black)?

A

CCB

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16
Q

What is the step 2 treatment for a patient with hypertension under the age of 55 and without black ethnicity. Also any patient with both hypertension and type 2 diabetes?

A

ACEi or ARB + CCB or thiazide-like duiretic

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17
Q

What is the step 2 treatment of a patient with hypertension without type 2 diabetes who is over 55 (or of any age but is black)?

A

CCB + ACEi or ARB or thiazide-like diuretic

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18
Q

What is the step 3 treatment for hypertension?

A

ACEi or ARB + CCB + thiazide-like duiretic

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19
Q

What is the step 4 treatment for hypertension?

A
  • Confirm resistant hypertension: confirm elevated BP with ABPM or HBPM, check for postural hypertension and discuss adherence
  • Consider seeking expert advice or adding a:
  • Low dose spironalactone if blood potassium levels are <4.5 mmol/l
  • Alpha-blocker or beta-blocker if blood potassium levels are >4.5 mmol/l
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20
Q

What does ACDC stand for?

A
  • ACE 1 or ARB
  • Calcium channel blocker
  • Diuretic (thiazide-like)
  • Call for help (resistant hypertension)
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21
Q

What type of drugs are RAAS inhibitors?

A
  • Angiotensin converting enzyme inhibitors

- Angiotensin AT1 receptor blockers

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22
Q

Name 3 ACEi

A
  • Ramipril
  • lisinopril
  • captopril
23
Q

Name 3 ARBs (angiotensin receptor antagonists)

A
  • Losartan
  • Candesartan
  • Irbesartan
24
Q

Name 3 CCBs (calcium channel blockers)

A
  • Amlodipine
  • Felodipine
  • Lercanidipine
25
Q

What are the two major classes of diuretics?

A
  • Thiazide-like diuretics

- High dose loop diuretics

26
Q

What class of drugs cannot be used when a patient has renal impairment?

A

Thiazide-like diuretics

27
Q

Name 2 drugs which are classed as thiazide-like diuretics

A
  • Indapamide

- Bendroflumethiazide

28
Q

Name a high dose loop diuretic

A

Furosemide

29
Q

What is resistant hypertension?

A

Hypertension that is poorly responsive to treatment and requires the use of multiple medications to achieve acceptable blood pressure ranges

30
Q

What additional classes of drugs can be used to treat resistant hypertension?

A
  • Sympathetic nervous system antagonists
    (Beta-blockers and arenoreceptor blockers)
  • Kidney function modifiers
    (Potassium sparing diuretics and aldosterone antagonists)
31
Q

When are Kidney function modifiers not used to treat resistant hypertension?

A
  • When K+ > 4.6 mmol/l

- Caution in renal impairment

32
Q

At what level of potassium are sympathetic nervous sytem antagonists used?

A

If K+ > 4.5 mmol/l

33
Q

Name 2 beta-blockers

A

Atenolol, bisoprolol

34
Q

Name a a1 blocker

A

Doxazosin

35
Q

Name 2 specific kidney function modifying drugs used to treat resistant hypertension

A
  • Amiloride

- Spironolactone

36
Q

How does doxazosin work to treat resistant hypertension?

A
  • It blocks alpha 1 resecptors
  • Blocking vasoconstriction
  • Resulting in vasodilation
  • Reducing resistance
  • decreasing bp
37
Q

What kind of drugs are used as a first line post MI and HF?

A

RAAS inhibitors

38
Q

What muscle cells do DHP-like CCBs have the greatest effect on?

A
  • Vascular smooth muscle
39
Q

What are the two major classes of kidney function modifiers?

A
  • Thiazide-like diuretics

- Aldosterone antagonists

40
Q

Name an aldosterone antagonist

A

Spironolactone

41
Q

How do thiazide-like diuretics reduce bp?

A
  • Inhibit Na+ reabsorption in nephron

- Also have a direct relaxant effect on vascular smooth muscle

42
Q

What are the common side-effects of ACEi?

A
  • Oersistant dry cough (15%), dizziness, tiredness, headaches
  • Slight increased risk of angioedema African/Caribbean ethnicity
  • Risk of hyperkalaemia (care with drug interactions)
  • Renal impairment - monitor (though can be reno-productive also)
  • Avoid in bilateral renal artery stenosis
  • Teratogenic
43
Q

What are the common side-effects of ARBs?

A
  • Dizziness, headaches, back/leg pain
  • Risk of hyperkalaemia, renal impairment
  • Avoid in bilat renal artery stenosis
  • Teratogenic
44
Q

What are the common side-effects of Dihydropyridine like calcium channel blockers?

A
  • FLushes
  • Headaches
  • Ankle oedema
  • Dizziness
45
Q

What are the common side-effects of thiazide-like diuretics?

A
  • Hypokalemia, hyponatraemia, gout, impotence
  • Monitor for dehydration
  • Ineffective in moderate to severe renal impairment (GFR<30mls/min)
46
Q

What are the common side-effects of aldosterone antagonist diuretics?

A
  • Hyperkalaemia
  • Renal impairment
  • GI upset
  • Spironalactone
  • Oestrogen related side-effects
47
Q

What are the pros of multi-drug treatment of hypertension?

A
  • Reduced mortality/morbidity
  • Each drug class working at different sites on body - can achieve BP treatment targets more quickly
  • Reduces dose burden of individual drugs thereby minimising side-effects
48
Q

What are the cons of multi-drug treatments for hypertension?

A
  • Concordnace problem
  • Side-effects may be more frequent
  • Increased drug cost to the NHS
49
Q

What should the target blood pressure be for a patient who presents with a blood pressure of 150/95 mmHg

A

< 140/90 mmHg

50
Q

What course of action shoulld you take for a patient who presents with a bp of 140/90 to 179/119?

A
  • Offer home or ambulatory bp
  • Investigate target organ damge
  • Assess CV risk
51
Q

What should the course of action be for a patient with an ABP of 135/85 to 149/94? who is under 40?

A

Consider specialist evaluation of secondary causes and assessment of long-term benefits and risks of treatment

52
Q

What should the course of action be for a patient with an ABP of 135/85 to 149/94? who is under 60 with 10-year CVD risk <10%?

A
  • Offer lifestyle advice and consider drug treatment
53
Q

What should the course of action be for a patient who presents with a clinic BP of 180/120 mmHg or more?

A
  • Assess for target organ damage as soon as possible
  • Consider starting drug treatment immeadetly without ABPM/HBPM if target organ damage
  • Repeat clinic BP in 7 days if no target organ damage
  • Refer for same-day specialist review if:
  • Retinal haemorrhage or papilloedema )accelerated hypertension or life-threatening symptoms or suspected pheochromocytoma

Pharmacology 3001 (13 decks)

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