Treating Hypertension Flashcards

1
Q

Complications of hypertension

A
Haemorrhage, stroke cognitive decline 
Retinopathy
Peripheral vascular disease
Renal failure 
LVF, CHD, CHF, MI
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2
Q

Framingham study

A

Increasing blood pressure is associated with a progressive increase in the risk of stroke and cardiovascular disease. The rise is exponential and also age is significant

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3
Q

Optimal blood pressure

A

<120/<80

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4
Q

Stage 1 hypertension

A

Clinic blood pressure is 140/90 or higher while ABPM daytime average is 135/85 or higher

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5
Q

Stage 2 hypertension

A

Clinic BP 160/100

ABPM daytime average 150/95 or higher

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6
Q

Severe hypertension

A

Clinic systolic >180 or diastolic <110

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7
Q

5-10% is secondary hypertension, what are some causes

A

Chronic renal disease(20%, chronic pyelonephritis, polycystic kidneys, fibromuscular dysplasia)
Renal artery stenosis
Endocrine disease (Cushing’s, Conn’s)
Drug induced (NSAIDs, oral contraceptives, corticosteroids)
Pregnancy (pre-eclampsia)
Vascular (coarctation of aorta)
Sleep apnoea

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8
Q

Factors that increase risk of mortality from hypertension

A
Cigarette smoking
Diabetes mellitus
Renal disease 
Male
Hyperlipidemia
Previous MI or stroke
Left ventricular hypertrophy
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9
Q

Aetiology of hypertension

A

Polygenic and polyfactorial

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10
Q

Age and hypertension and treatment for the elderly

A

Rises with age but should be treated aggressively in elderly as reduces MI.
But, drugs are bad in elderly w

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11
Q

Genetics and hypertension

A

Over 30 genes are recognised but they have only a small effect
Closest correlation is between siblings, possibly environment in families

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12
Q

Reducing salt intake

A

Good in hypertensive adults but no effect on normotensives

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13
Q

Average fall in those who reduce alcohol intake

A

3/5mmHg

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14
Q

Weight and hypertension

A

Up to 30% is just weight
A weight loss of 9kg in untreated patients can produce a fall of 118mmHg
In treated then 30/21 has been reported

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15
Q

Birth weight and hypertension

A

The lower the birth weight the higher the likelihood of hypertension

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16
Q

Race and hypertension

A

Black populations are genetically selected to be salt retainers so are more sensitive to high salt and also respond more to stress

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17
Q

Conditions to assess risk in treating hypertension

A

Previous MI, smoking, diabetes mellitus, hypercholesterolemia, family history, physical examination
End organ damage (do ECG, proteinuria, renal US)

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18
Q

When should hypertension treatment be started

A

An overall CVD of 20% in 10 years

19
Q

What does BHS suggest the target BP should be

A

<135/80/85mmHg

20
Q

Main reasons for treating hypertension

A

Reducing cerebrovascular disease by 40-50% and MI by 16-30%

21
Q

What drug is used more in young people

A

ACE inhibitors (or ARB)

22
Q

Which drugs are used more in older people with less renin

A

Calcium channel blockers

Thiazide type diuretics

23
Q

When to offer type 1 hypertension therapy

A
People under 80 years old with >135/85 and
Target organ damage 
Established CVD
Renal disease 
Diabetes
A ten year CB risk>20% in 10 years
24
Q

stage 2 hypertension

A

ABPM >150/95

Always treat

25
People aged under 40 with hypertension
Seek specialist help for secondary causes or organ damage
26
Blood pressure target in over 80s
145/85 instead of 135/80-85
27
Step 1 treatment for people aged over 55 and black/Caribbean people and pregnant/ child bearing age women
Calcium channel blockers If not suitable (oedema or intolerance or heart failure) Thiazide like diuretic
28
Step one treatment for under 55s
ACE inhibitors/ARB | except for afro-caribbeans or women of childbearing age
29
Step 2 treatment
Add thiazide type diuretic eg clortalidone or idapamide
30
Step 3
Combine CCB, ACEI, diuretic
31
Step 4
Resistant hypertension. Consider further diuretic therapy with low dose spironolactone (25mg/day) if blood K is under 4.5mmol/l If not give higher thiazide like diuretic
32
Angiotensin converting enzyme inhibitors (ACEI) and example
RAMIPRIL | competitively inhibits the actions of angiotensin converting enzyme
33
Contradiction to giving ACE1, pregnancy/ child bearing age
Renal artery stenosis, failure, hyperkalemia
34
Adverse drug reactions to ACEI
Cough, first dose hypotension, taste disturbance, renal impairment
35
Drug drug interactions with ACEI
NSAIDS (acute renal failure) Potassium supplements Potassium sparing diuretics (hyperkalemia)
36
Angiotensin 2 antagonists (ARB)
Eg losartan, valsartan Competitively block angiotensin 2 T AT1 receptor Don't give cough like ACEI
37
Calcium channel blockers
Eg amlodipine/felodipine (vasodilators) Verapimil/diltiazem (rate limiting) Work by blocking L type cc Relaxing arteries to reduce peripheral resistance Reducing CO For over 55s and women who could get pregnant
38
Contraindications for CCB
Acute Mi | Heart failure, bradycardia (only rate limiting)
39
Adverse drug reactions for CCBs
Flushing Headache Ankle oedema Indigestion and reflux oesophagitis
40
Thiazide type diuretics
Eg idapamide, clortalidone Used for black people Can be used in combination and lowers strike and MI Urinary excretion of sodium, may take weeks
41
Adverse drug reactions for TTD (thiazide type diuretic)
Uncommon but gout and impotence
42
Alpha adrenoceptor antagonists
Doxazosin blocks post synaptic. Opposes vascular smooth muscle contraction in arteries Can cause first dose hypotension, dizziness, dry mouth, headache
43
Methyldopa
Used mainly in pregnancy Acts on CNS adrenoceptors to decrease central sympathetic outflow Sedation and drowsiness and nasal congestion and dry mouth
44
Pre-eclampsia
Severe BP rise from 20 weeks to >140/90 and proteinuria>300mg/24hr