The Treatment of Hypertension Flashcards
what are the two best methods to measure hypertension to confirm it is true hypertension?
ABPM and HBPM
at what time of the day are ABPM readings usually taken?
daytime, nighttime is best but there it is unconfortable for patient
what are the risk factors of morbiditiy to look out for in a history of a hypertensive?
previous MI, stroke or IHDsmokingdiabetes mellitishypercholesterolaemiafamily history of the condition
what investigations can be used to assess end organ damage in hypertensives?
ECGechocardiogramproteinuriaranl ultrasoundrenal function
what is ecg used to look for when investigating end organ damage from hypertension?
left ventricular hyoertrophy
what is an echocardiogram used for when investigating end organ damage from hypertension?
left ventricular hypertrophy
what is a renal ultrasound used for when investigating end organ damage from hypertension?
looking for signs of renal disease
which conditions should be screened for in hypertensives as they are curable?
cushing’s diseaseConn’s syndromerenal artery stenosisfibromuscular dysplasiasleep apnoea
what are the signs on an ecg of hypertension?
deep s waves in V1tall R waves in V5(showing LVH)
what scoring system can used to estimate the risk of CVD in hypertensives?
the assign risk calculator
what is the target blood pressure of hypertensives after treatment (according to BHS)?
<135/80-85mmHg
when should treatment be started for hypertension (in terms of risk of CVD)?
20%/10 years
when treating hypertension which is not improving with treatment do you add more treatments on or increase the dose of the original treatment?
add more treatments
what class of anti-hypertensive drugs does the BHS advise giving to young people?
ACE inhibitorsARB (angiotensin II receptor blockers)
what class of anti-hypertensive drugs does the BHS advise giving to the elderly and afro-caribbeans ?
calcium channel blockers thiazde-type diuretics
when should anti-hypertensive treatment be given to patients under 80?
if they have a ABPM of >135/85. and one or more of the followingtarget organ damageestablished cardiovascular diseaserenal diseasediabetesa 10 year cardiovascular disease risk equivalent to 20% or greater
when should anti-hypertensive drugs be given to type 2 hypertensives?
any patient with stage 2 hypertension should be given treatment
what should be done if a patient under 40 years is hypertensive (any stage)?
seek specialist evaluation of secondary causes and for a more detailed assessment of potential target organ damage
how does treatment of hypertension differ in people aged 80 or greater?
use same antihypertensive drugs as for people aged 55-80, target blood pressure is just greater (<145/85)
what is white coat hypertension?
hypertension caused by being in a clinical envionment
what must be carried out when measured when a patient is suspected of white coat hypertension?
ABPM or HBPM
what is the step 1 treatment of hypertensives over 55 years or of african or caribbean family origin?
calcium channel blockers
what is given to hypertensives over 55 years or of african or caribbean origin if CCB are contraindicated?
thiazide-like diuretic
what are the contraindications for calcium channel blockers?
oedemaintoleranceevidence of heart failurehigh risk of heart failure
what is step 1 treatment for hypertensives under 55 years?
ACE inhibitorsARB
when should ACE inhibitors and ARB not be given to hypertensives under 55years?
if they are Afro-Caribbeanor women of child baring age
what is the step 2 treatment for hypertension in under 55s?
add thiazide-type diuretic to ACEI or ARB
what is the step 2 treatment for hypertensives over 55 or afro-caribbeans?
add thiazide-type diuretic to CCB
what is the step 3 treatment for hypertensive?
add CCB, ACEI and diuretic together
when initiating or changing a diuretic what should be offered?
a thiazide-like diuretic
name some thiazide-like diuretics?
chlortalidoneindapamide
what type of hypertension should be treated by step 4 treatment?
resistant hypertension
what is the step 4 treatment of hypertensives with low potassium levels?
further diuretic therapy with low-dose spironolactone
what is the step 4 treatment of hypertensives with high potassium levels or reduced GFR?
higher-dose thiazide-like diuretic treatment
what is the ACEI widely used ?
ramipril
what is the advantage of ACEIs?
prevents organ damge
what are the contraindications of ramipril (ACEi)?
Renal artery stenosisRenal failureHyperkalaemia
what are the adverse drug reactions of ramipril (ACEi)?
coughfirst dose hypotensiontaste disturbancerenal impairmentangioneurotic oedema
which drugs does ramipril interact with?
NSAIDspotassium supplementspotassium sparing diuretics
what is the outcome of an interaction between ramipril and NSAIDs?
acute renal failure
what is the outcome of an interaction between ramipril and potassium supplements?
hyperkalaemia
what is the outcome of an interaction between ramipril and potassium sparing diuretics?
hyperkalaemia
name some ARBs?
losartan, valsartan, candesartan, irbesartan
what is the advantage of ARBs over ACEIs?
they do not produce a cough a a side effect
what are the common CCBs?
amlodipine, felodipine, verapamil, diltiazem
how do amlodipine and felodipine work?
they are vaodilators
how do verapamil and diltiazem work?
heart rate limiting
how do CCBs work?
blocking the L type calcium channelsselectivity between vascular and cardiac L type channelsrelaxing large and small arteries and reducing peripheral resistancereducing cardiac output
when are vasodilating CCBs used?
over 55years. women of child baring age
what are the contraindications of CCBs?
Acute MIHeart failure, bradycardia (rate limiting CCBs)
what are the adverse affects if CCBs?
FlushingHeadacheAnkle oedemaIndigestion and reflux oesophagitisrate limiting agents can cause constipation and bradycardia
what is the thiazide-type diuretic drug used on the UK?
indapamide
what is indapamide commonly the first line treatment for?
mil-moderate hypertension in afro-caribbeans
what does indapamide reduce the risk of?
MI and stroke
what are the side effects of indapamide?
uncommon but can include gout and impotence
what is the alpha-adrenoreceptor antagonist sometimes used to treat hypertension?
doxazosin
when is doxazosin contrindicated?
when the patient has underlying heart failure as it can exacerbate it
what are the centrally acting agents for hypertension?
methyldopamoxonidine
what vasodilatots are occasionally used to treat hypertension?
hydralazineminoxidil
why are hydralazine and minoxidil rarely used?
they have horrendous side effects
what are the adverse drug reactions of doxazosin?
first dose hypotensiondizzinessdry mouthheadache
what is the main use of methyl dopa?
treating hypertension in pregnant women
what are the adverse drug reaction s of methyldopa?
sedation and drowsinessdry mouth and nasal congestionorthostatic (postural) hypotension
what is a common treatment regime for a hypertensive over 55years of age?
- start CCB2. add thiaside type diuretic3. add ACE inhibitor4. add Beta blocker5. add one of the less commonly used agents
what is a common treatment regime for a young hypertensive ?
- start ACEI (if child bearing ages CCB or Beta blocker)2. add thiazide type diuretic3. add calcium channel blocker4. add beta blocker 5. add one of the less commonly used agents
what does blood pressure normally do during pregnancy?
falls
what is the hypertension that develops during pregnancy called?
gestational hypertension
what is preeclampsia?
severe rise in blood pressure during pregnancy to >140/90 mmHg and proteinuria >300mg/24h
what is the risk to the baby is mother has hypertension?
growth retardation
what is the treatment for hypertension in a woman prepregnancy?
nifedipine MR, methyl dopa, atenolol, labetalol
which treatments are added during pregnancy to the existing treatments given prepregancy for hypertension?
thiazide diuretic and /or amlodipine
which drugs are given to a pregnant woman with preeclampsia?
normal drugs during pregnancy plus, IV hydralazine, esmolol, labetalol
