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Cardiovascular System > Treating Hypertension > Flashcards

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
Q

People aged under 40 with hypertension

A

Seek specialist help for secondary causes or organ damage

26
Q

Blood pressure target in over 80s

A

145/85 instead of 135/80-85

27
Q

Step 1 treatment for people aged over 55 and black/Caribbean people and pregnant/ child bearing age women

A

Calcium channel blockers

If not suitable (oedema or intolerance or heart failure)
Thiazide like diuretic

28
Q

Step one treatment for under 55s

A

ACE inhibitors/ARB

except for afro-caribbeans or women of childbearing age

29
Q

Step 2 treatment

A

Add thiazide type diuretic eg clortalidone or idapamide

30
Q

Step 3

A

Combine CCB, ACEI, diuretic

31
Q

Step 4

A

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
Q

Angiotensin converting enzyme inhibitors (ACEI) and example

A

RAMIPRIL

competitively inhibits the actions of angiotensin converting enzyme

33
Q

Contradiction to giving ACE1, pregnancy/ child bearing age

A

Renal artery stenosis, failure, hyperkalemia

34
Q

Adverse drug reactions to ACEI

A

Cough, first dose hypotension, taste disturbance, renal impairment

35
Q

Drug drug interactions with ACEI

A

NSAIDS (acute renal failure)
Potassium supplements
Potassium sparing diuretics (hyperkalemia)

36
Q

Angiotensin 2 antagonists (ARB)

A

Eg losartan, valsartan

Competitively block angiotensin 2 T AT1 receptor
Don’t give cough like ACEI

37
Q

Calcium channel blockers

A

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
Q

Contraindications for CCB

A

Acute Mi

Heart failure, bradycardia (only rate limiting)

39
Q

Adverse drug reactions for CCBs

A

Flushing
Headache
Ankle oedema
Indigestion and reflux oesophagitis

40
Q

Thiazide type diuretics

A

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
Q

Adverse drug reactions for TTD (thiazide type diuretic)

A

Uncommon but gout and impotence

42
Q

Alpha adrenoceptor antagonists

A

Doxazosin blocks post synaptic. Opposes vascular smooth muscle contraction in arteries
Can cause first dose hypotension, dizziness, dry mouth, headache

43
Q

Methyldopa

A

Used mainly in pregnancy
Acts on CNS adrenoceptors to decrease central sympathetic outflow
Sedation and drowsiness and nasal congestion and dry mouth

44
Q

Pre-eclampsia

A

Severe BP rise from 20 weeks to >140/90 and proteinuria>300mg/24hr

Cardiovascular System (33 decks)

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