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Cardiovascular system > the treatment of hypertension > Flashcards

the treatment of hypertension Flashcards

1
Q

what are the two best methods to measure hypertension to confirm it is true hypertension?

A

ABPM and HBPM

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2
Q

at what time of the day are ABPM readings usually taken?

A

daytime, nighttime is best but there it is unconfortable for patient

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3
Q

what are the risk factors of morbiditiy to look out for in a history of a hypertensive?

A 
previous MI, stroke or IHD
smoking
diabetes mellitis
hypercholesterolaemia
family history of the condition
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4
Q

what investigations can be used to assess end organ damage in hypertensives?

A 
ECG
echocardiogram
proteinuria
ranl ultrasound
renal function
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5
Q

what is ecg used to look for when investigating end organ damage from hypertension?

A

left ventricular hyoertrophy

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6
Q

what is an echocardiogram used for when investigating end organ damage from hypertension?

A

left ventricular hypertrophy

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7
Q

what is a renal ultrasound used for when investigating end organ damage from hypertension?

A

looking for signs of renal disease

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8
Q

which conditions should be screened for in hypertensives as they are curable?

A 
cushing's disease
Conn's syndrome
renal artery stenosis
fibromuscular dysplasia
sleep apnoea
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9
Q

what are the signs on an ecg of hypertension?

A

deep s waves in V1
tall R waves in V5
(showing LVH)

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10
Q

what scoring system can used to estimate the risk of CVD in hypertensives?

A

the assign risk calculator

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11
Q

what is the target blood pressure of hypertensives after treatment (according to BHS)?

A

<135/80-85mmHg

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12
Q

when should treatment be started for hypertension (in terms of risk of CVD)?

A

20%/10 years

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13
Q

when treating hypertension which is not improving with treatment do you add more treatments on or increase the dose of the original treatment?

A

add more treatments

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14
Q

what class of anti-hypertensive drugs does the BHS advise giving to young people?

A

ACE inhibitors

ARB (angiotensin II receptor blockers)

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15
Q

what class of anti-hypertensive drugs does the BHS advise giving to the elderly and afro-caribbeans ?

A

calcium channel blockers

thiazde-type diuretics

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16
Q

when should anti-hypertensive treatment be given to patients under 80?

A 
if they have a ABPM of >135/85. 
and one or more of the following
target organ damage
established cardiovascular disease
renal disease
diabetes
a 10 year cardiovascular disease risk equivalent to 20% or greater
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17
Q

when should anti-hypertensive drugs be given to type 2 hypertensives?

A

any patient with stage 2 hypertension should be given treatment

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18
Q

what should be done if a patient under 40 years is hypertensive (any stage)?

A

seek specialist evaluation of secondary causes and for a more detailed assessment of potential target organ damage

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19
Q

how does treatment of hypertension differ in people aged 80 or greater?

A

use same antihypertensive drugs as for people aged 55-80, target blood pressure is just greater (<145/85)

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20
Q

what is white coat hypertension?

A

hypertension caused by being in a clinical envionment

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21
Q

what must be carried out when measured when a patient is suspected of white coat hypertension?

A

ABPM or HBPM

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22
Q

what is the step 1 treatment of hypertensives over 55 years or of african or caribbean family origin?

A

calcium channel blockers

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23
Q

what is given to hypertensives over 55 years or of african or caribbean origin if CCB are contraindicated?

A

thiazide-like diuretic

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24
Q

what are the contraindications for calcium channel blockers?

A

oedema
intolerance
evidence of heart failure
high risk of heart failure

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25
Q

what is step 1 treatment for hypertensives under 55 years?

A

ACE inhibitors

ARB

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26
Q

when should ACE inhibitors and ARB not be given to hypertensives under 55years?

A

if they are Afro-Caribbean

or women of child baring age

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27
Q

what is the step 2 treatment for hypertension in under 55s?

A

add thiazide-type diuretic to ACEI or ARB

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28
Q

what is the step 2 treatment for hypertensives over 55 or afro-caribbeans?

A

add thiazide-type diuretic to CCB

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29
Q

what is the step 3 treatment for hypertensive?

A

add CCB, ACEI and diuretic together

30
Q

when initiating or changing a diuretic what should be offered?

A

a thiazide-like diuretic

31
Q

name some thiazide-like diuretics?

A

chlortalidone

indapamide

32
Q

what type of hypertension should be treated by step 4 treatment?

A

resistant hypertension

33
Q

what is the step 4 treatment of hypertensives with low potassium levels?

A

further diuretic therapy with low-dose spironolactone

34
Q

what is the step 4 treatment of hypertensives with high potassium levels or reduced GFR?

A

higher-dose thiazide-like diuretic treatment

35
Q

what is the ACEI widely used ?

A

ramipril

36
Q

what is the advantage of ACEIs?

A

prevents organ damge

37
Q

what are the contraindications of ramipril (ACEi)?

A

Renal artery stenosis
Renal failure
Hyperkalaemia

38
Q

what are the adverse drug reactions of ramipril (ACEi)?

A 
cough
first dose hypotension
taste disturbance
renal impairment
angioneurotic oedema
39
Q

which drugs does ramipril interact with?

A

NSAIDs
potassium supplements
potassium sparing diuretics

40
Q

what is the outcome of an interaction between ramipril and NSAIDs?

A

acute renal failure

41
Q

what is the outcome of an interaction between ramipril and potassium supplements?

A

hyperkalaemia

42
Q

what is the outcome of an interaction between ramipril and potassium sparing diuretics?

A

hyperkalaemia

43
Q

name some ARBs?

A

losartan, valsartan, candesartan, irbesartan

44
Q

what is the advantage of ARBs over ACEIs?

A

they do not produce a cough a a side effect

45
Q

what are the common CCBs?

A

amlodipine, felodipine, verapamil, diltiazem

46
Q

how do amlodipine and felodipine work?

A

they are vaodilators

47
Q

how do verapamil and diltiazem work?

A

heart rate limiting

48
Q

how do CCBs work?

A

blocking the L type calcium channels
selectivity between vascular and cardiac L type channels
relaxing large and small arteries and reducing peripheral resistance
reducing cardiac output

49
Q

when are vasodilating CCBs used?

A

over 55years.

women of child baring age

50
Q

what are the contraindications of CCBs?

A

Acute MI

Heart failure, bradycardia (rate limiting CCBs)

51
Q

what are the adverse affects if CCBs?

A 
Flushing
Headache
Ankle oedema
Indigestion and reflux oesophagitis
rate limiting agents can cause constipation and bradycardia
52
Q

what is the thiazide-type diuretic drug used on the UK?

A

indapamide

53
Q

what is indapamide commonly the first line treatment for?

A

mil-moderate hypertension in afro-caribbeans

54
Q

what does indapamide reduce the risk of?

A

MI and stroke

55
Q

what are the side effects of indapamide?

A

uncommon but can include gout and impotence

56
Q

what is the alpha-adrenoreceptor antagonist sometimes used to treat hypertension?

A

doxazosin

57
Q

when is doxazosin contrindicated?

A

when the patient has underlying heart failure as it can exacerbate it

58
Q

what are the centrally acting agents for hypertension?

A

methyldopa

moxonidine

59
Q

what vasodilatots are occasionally used to treat hypertension?

A

hydralazine

minoxidil

60
Q

why are hydralazine and minoxidil rarely used?

A

they have horrendous side effects

61
Q

what are the adverse drug reactions of doxazosin?

A

first dose hypotension
dizziness
dry mouth
headache

62
Q

what is the main use of methyl dopa?

A

treating hypertension in pregnant women

63
Q

what are the adverse drug reaction s of methyldopa?

A

sedation and drowsiness
dry mouth and nasal congestion
orthostatic (postural) hypotension

64
Q

what is a common treatment regime for a hypertensive over 55years of age?

A
  1. start CCB
  2. add thiaside type diuretic
  3. add ACE inhibitor
  4. add Beta blocker
  5. add one of the less commonly used agents
65
Q

what is a common treatment regime for a young hypertensive ?

A
  1. start ACEI (if child bearing ages CCB or Beta blocker)
  2. add thiazide type diuretic
  3. add calcium channel blocker
  4. add beta blocker
  5. add one of the less commonly used agents
66
Q

what does blood pressure normally do during pregnancy?

A

falls

67
Q

what is the hypertension that develops during pregnancy called?

A

gestational hypertension

68
Q

what is preeclampsia?

A

severe rise in blood pressure during pregnancy to >140/90 mmHg and proteinuria >300mg/24h

69
Q

what is the risk to the baby is mother has hypertension?

A

growth retardation

70
Q

what is the treatment for hypertension in a woman prepregnancy?

A

nifedipine MR, methyl dopa, atenolol, labetalol

71
Q

which treatments are added during pregnancy to the existing treatments given prepregancy for hypertension?

A

thiazide diuretic and /or amlodipine

72
Q

which drugs are given to a pregnant woman with preeclampsia?

A

normal drugs during pregnancy plus, IV hydralazine, esmolol, labetalol

Cardiovascular system (40 decks)

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