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Cardiovascular > Treatment of Hypertension > Flashcards

Treatment of Hypertension Flashcards

1
Q

Define stage 1 hypertension

A

Clinical blood pressure is 140/90 mmHg or higher

ABPM daytime average is 135/85 mmHg or higher

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2
Q

Define stage 2 hypertension

A

Clinic blood pressure is 160/100 mmHg or higher

ABPM daytime average 150/95 mmHg or higher.

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3
Q

Define severe hypertension

A

Clinic systolic blood pressure is 180 mmHg or higher or diastolic blood pressure is 110 mmHg or higher.

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4
Q

What do you use to measure true blood pressure?

A

Ambulatory Blood Pressure Monitoring

Home Blood Pressure Monitoring

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5
Q

When treating a patient with hypertension what is considered when assessing their risk?

A 
Previous MI
Stroke 
Ischaemic heart disease
Smoking 
Diabetes mellitus 
Hypercholesterolaemia 
Family history 
Physical examination
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6
Q

What tests are carried out to assess for end organ damage?

A

Check for left ventricular hypertrophy on an ECG or echocardiogram
ACR
Renal ultrasound
eGFR

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7
Q

What are some causes of hypertension that are treatable?

A

Renal artery stenosis
Cushings disease
Conn’s disease
Sleep apnoea

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8
Q

What do you use to assess risk correctly?

A

Assign risk calculator

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9
Q

What is the target blood pressure for patients under 80?

A

Less than 135/80-85 mmHg

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10
Q

When should treatment be started for hypertension?

A

An overall risk of developing cardiovascular disease of 20% over 10 years

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11
Q

In general how is hypertension treated?

A

By using a stepped approach

Low doses of several drugs

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12
Q

What is meant by using a stepped approach?

A

Don’t continuously change medication

Add new medication to current therapy until the target blood pressure is achieved

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13
Q

What is the target blood pressure for patients 80 and over?

A

Less than 145/85

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14
Q

What medication do you use to treat high renin hypertension?

A

ACE inhibitors

Angiotensin II receptor blockers (ARB)

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15
Q

What medication do you use to treat low renin hypertension?

A

Calcium channel blockers

Thiazide-type diuretic

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16
Q

What is the treatment of stage 1 hypertension?

A

Antihypertensive drug treatment for under 80 with one or more of:

  • target organ damage
  • established cardiovascular disease
  • renal disease
  • diabetes
  • 10 year CVD risk equivalent to 20% or more
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17
Q

What is the treatment of stage 2 hypertension?

A

Offer antihypertensive drug treatment to people of any age with stage 2 hypertension

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18
Q

What is step 1 treatment?

A

If a patient is under 55 offer ACEI/ARB but not to Afro-caribbeans or women of child baring age
For these people offer CCB

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19
Q

What is step 2 treatment?

A

Add Thiazide-type diuretic

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20
Q

What are some Thiazide-type diuretics?

A

Clortalidone

Indapamide

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21
Q

What is step 3 treatment?

A

Add CCB, ACEI and Diuretic together

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22
Q

In step 4 treatment what is done if blood potassium is higher than 4.5 mmol/l?

A

Higher-dose Thiazide-type diuretic treatment

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23
Q

When is low-dose spironolactone used?

A

If blood potassium is 4.5 mmol/l or lower

24
Q

What is angiotensin II?

A

A potent vasoconstrictor and hypertrophogenic agent

25
Q

What does ACE do?

A

Converts angiotensin I to active angiotensin II

26
Q

Give examples of ACE inhibitors

A

Ramipril

Perindopril

27
Q

What effect can angiotensin have on the body?

A

Organ damage that causes strokes, hypertension, heart failure, myocardial infarction and renal failure which all lead to death

28
Q

What are ARBs?

A

Angiotensin II antagonists

29
Q

What is the advantage of ARBs over ACE inhibitors?

30
Q

What are the two types of calcium channel blockers?

A

Vasodilators

Rate limiting

31
Q

Give examples of vasodilator CCBs?

A

Amlodipine

Felodipine

32
Q

Give examples of rate limiting CCBs?

A

Verapamil

Diltiazem

33
Q

What channels do calcium channel blockers block?

A

L type calcium channels between vascular and cardiac muscles

34
Q

What is the effect of CCBs?

A

Relaxing large and small arteries and reducing peripheral resistance, reducing cardiac output

35
Q

When are vasodilating CCBs used?

A

With over 55 year olds and women of child baring age

36
Q

What is the mechanism of action of Thiazide-type diuretics?

A

Blocks reabsorption of sodium and enhanced urinary sodium loss

37
Q

What type of drug is Doxazosin?

A

Alpha-adrenoceptor antagonist

38
Q

What does Doxazosin do?

A

Selectively block post synaptic alpha-1-adrenoreceptors

Oppose vascular smooth muscle contraction in arteries

39
Q

Name some centrally acting agents for hypertension

A

Methyldopa

Moxonidine

40
Q

Name some vasodilators used in hypertension treatment

A

Hydralazine

Minoxidil

41
Q

When is Methyldopa used?

A

It is mainly used in the treatment of hypertension of pregnancy

42
Q

What can primary hypertension cause in pregnant women?

A

Preeclampsia

43
Q

How serious is hypertension in pregnancy?

A

Very, it is the second most common cause of maternal and fetal death

44
Q

What should a woman of birthing age never be given?

A

ACE inhibitors

ARB

45
Q

How is hypertension in children in the UK defined?

A

Blood pressure in the 98th or higher centile

46
Q

What can childhood hypertension lead to?

A

Adult hypertension

Target organ damage

47
Q

What end organ damage is associated with childhood hypertension?

A 
Left ventricular hypertrophy (LVH)
Decreased vascular responsiveness
Increased carotid artery intimal medial thickness (cIMT)
Reduced GFR
Increased atheroma deposition
Reduced cognitive scores
48
Q

What are the most common causes of hypertension in newborn infants?

A

Renal artery thrombosis
Renal artery stenosis
Congenital renal malformation
Coarctation

49
Q

What are the most common causes of hypertension in infants up to 6 years?

A

Renal parenchymal disease
Coarctation
Renal artery stenosis

50
Q

What are the most common causes of hypertension in 6 to 10 year olds?

A

Renal parenchymal disease
Renal artery stenosis
Primary hypertension

51
Q

What are the most common causes of hypertension in 10 to 18 year olds?

A

Primary hypertension

Renal parenchymal disease

52
Q

What is accelerated hypertension?

A

A recent significant increase over beeline blood pressure that is associated with target organ damage

53
Q

What is hypertension urgency?

A

Severe hypertension with no evidence of target organ damage. “urgency” rather than “emergency”

54
Q

What is accelerated hypertension associated with?

A 
Primary hypertension and prescribed antihypertensive agents 
Lack of healthcare 
Poor blood pressure control 
Non adherence to medication 
Illicit drug use
55
Q

How is accelerated hypertension treated?

A

Reduce blood pressure by 15-20% over a period of 30-60 minutes
Use intravenous agents to stabilise then introduce oral therapy

56
Q

What medication should be used if there is pulmonary oedema in accelerated hypertension?

A

IV GTN
IV furosemide
Amlodipine and other oral medication once patient stable

57
Q

What medication should be used if there is encephalopathy in accelerated hypertension?

A

IV nicardipine
IV labetalol
IV esmolol
Amlodipine and other oral medication once patient stable

Cardiovascular (34 decks)

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