Treating Hypertension Flashcards
What score is used to calculate someones 10 year risk of having a cardiovascular event?
The Qrisk2 score incorporates blood pressure, age, smoking, cholesterol levels all into one risk.
When do we start treating hypertension?
Stage I- 140/90
What are some secondary causes of hypertension?
Conns syndrome Phaeochromocytoma Coarctation of the aorta Renal artery stenosis Alcohol abuse
What is the first line of treatment in hypertension for a 60yo black female?
Calcium channel blocker
What is the first line of treatment for a 32yo white male?
ACE inhibitor
What is the next stage of treatment for hypertension if ACEi or CCB have failed?
Offer both
What is the next stage of treatment if offering both an ACEi and a CCB has failed?
Offer a thiazide like diuretic
What is the final stage of treatment in hypertension if addition of thiazide like diuretics has failed?
Consider adding low dose spironolactone. Seek specialist advice and re-evaluate for secondary causes of hypertension.
What are the major types of Calcium channel blocker?
Dihydropyridines eg amlodipine
Verapimil
Dilitiazem
What is the mechanism of action of amlodipine?
Vasodilation of peripheral arterioles. This causes lower afterload.
What is the mechanism of action of verapimil?
Slows and reduces force of contraction of heart. Also slows conduction through the AV node.
What is the mechanism of action of dilitiazem?
Slows the heart and causes peripheral vasodilation
What are the adverse effects of using verapimil?
CNS- headaches and dizziness
Constipation
Heart block as prolongs AV node conduction, bradycardia
What are the adverse effects of using dilitiazem?
Constipation
Ankle oedema
Flushing
Headache
Why dont calcium channel blockers have effects on skeletal muscle?
Skeletal muscle does not rely on an exogenous source of Ca2+, it has its own store within the sarcoplasmic reticulum.
