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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
What does ACE do?
Converts angiotensin I to active angiotensin II
26
Give examples of ACE inhibitors
Ramipril | Perindopril
27
What effect can angiotensin have on the body?
Organ damage that causes strokes, hypertension, heart failure, myocardial infarction and renal failure which all lead to death
28
What are ARBs?
Angiotensin II antagonists
29
What is the advantage of ARBs over ACE inhibitors?
No cough
30
What are the two types of calcium channel blockers?
Vasodilators | Rate limiting
31
Give examples of vasodilator CCBs?
Amlodipine | Felodipine
32
Give examples of rate limiting CCBs?
Verapamil | Diltiazem
33
What channels do calcium channel blockers block?
L type calcium channels between vascular and cardiac muscles
34
What is the effect of CCBs?
Relaxing large and small arteries and reducing peripheral resistance, reducing cardiac output
35
When are vasodilating CCBs used?
With over 55 year olds and women of child baring age
36
What is the mechanism of action of Thiazide-type diuretics?
Blocks reabsorption of sodium and enhanced urinary sodium loss
37
What type of drug is Doxazosin?
Alpha-adrenoceptor antagonist
38
What does Doxazosin do?
Selectively block post synaptic alpha-1-adrenoreceptors | Oppose vascular smooth muscle contraction in arteries
39
Name some centrally acting agents for hypertension
Methyldopa | Moxonidine
40
Name some vasodilators used in hypertension treatment
Hydralazine | Minoxidil
41
When is Methyldopa used?
It is mainly used in the treatment of hypertension of pregnancy
42
What can primary hypertension cause in pregnant women?
Preeclampsia
43
How serious is hypertension in pregnancy?
Very, it is the second most common cause of maternal and fetal death
44
What should a woman of birthing age never be given?
ACE inhibitors | ARB
45
How is hypertension in children in the UK defined?
Blood pressure in the 98th or higher centile
46
What can childhood hypertension lead to?
Adult hypertension | Target organ damage
47
What end organ damage is associated with childhood hypertension?
``` Left ventricular hypertrophy (LVH) Decreased vascular responsiveness Increased carotid artery intimal medial thickness (cIMT) Reduced GFR Increased atheroma deposition Reduced cognitive scores ```
48
What are the most common causes of hypertension in newborn infants?
Renal artery thrombosis Renal artery stenosis Congenital renal malformation Coarctation
49
What are the most common causes of hypertension in infants up to 6 years?
Renal parenchymal disease Coarctation Renal artery stenosis
50
What are the most common causes of hypertension in 6 to 10 year olds?
Renal parenchymal disease Renal artery stenosis Primary hypertension
51
What are the most common causes of hypertension in 10 to 18 year olds?
Primary hypertension | Renal parenchymal disease
52
What is accelerated hypertension?
A recent significant increase over beeline blood pressure that is associated with target organ damage
53
What is hypertension urgency?
Severe hypertension with no evidence of target organ damage. "urgency" rather than “emergency”
54
What is accelerated hypertension associated with?
``` Primary hypertension and prescribed antihypertensive agents Lack of healthcare Poor blood pressure control Non adherence to medication Illicit drug use ```
55
How is accelerated hypertension treated?
Reduce blood pressure by 15-20% over a period of 30-60 minutes Use intravenous agents to stabilise then introduce oral therapy
56
What medication should be used if there is pulmonary oedema in accelerated hypertension?
IV GTN IV furosemide Amlodipine and other oral medication once patient stable
57
What medication should be used if there is encephalopathy in accelerated hypertension?
IV nicardipine IV labetalol IV esmolol Amlodipine and other oral medication once patient stable

Cardiovascular (34 decks)

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