Treatment of Hypertension and Heart Failure Flashcards

1
Q

What are the 2 elements of control of blood pressure?

A

The autonomic nervous system, and the RAAS system

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2
Q

What is RAAS?

A

Renin-angiotensin-aldosterone system which allows the kidney to control blood pressure

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3
Q

Describe the mechanism of action of the RAAS system.

A

Decreased renal perfusion due to low blood pressure causes increased release of renin.
Renin converts angiotensinogen to angiotensin 1.
ACE converts angiotensin 1 to angiotensin 2.
Angiotensin 2 causes 3 things to happen:
1. Increased aldosterone output
2. Direct salt and water retention in kidney
3. Causes vasoconstriction

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4
Q

What are the 3 BHS classifications of hypertension?

A
Grade 1 (mild) 140-159/90-99
Grade 2 (moderate) 160-179/100-109
Grade 3 (severe) >180/>110
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5
Q

What are the first line treatments for hypertension in pts under 55?

A

ACE inhibitor or ARB if not tolerated

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6
Q

What are the second line treatments for hypertension in pts under 55?

A

Combining a calcium channel blocker with the ACEI/ARB

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7
Q

What are the third line treatment for hypertension in pts under 55?

A

ACEI/ARB + Calcium channel blocker + thiazide diuretic

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8
Q

What are the fourth line treatments for hypertension in pts under 55?

A

ACEI/ARB + Calcium Channel blocker + Thiazide diuretic + Low does spironolactone

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9
Q

What are the first line treatments for hypertension in pts over 55 or of African or Caribbean origin?

A

Calcium Channel blocker

Or

Thiazide diuretic if CCB not tolerated

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10
Q

What are the second line treatments for hypertension in pts over 55 or of Africa or Caribbean origin?

A

CCB or Thiazide diuretic, + ACEI/ARB

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11
Q

What are the third line treatment for hypertension in pts over 55 or of African or Caribbean origin?

A

ACEI/ARB + Calcium Channel blocker + Thiazide diuretic

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12
Q

What are the fourth line treatment for hypertension in pts over 55 or of African or Caribbean origin?

A

ACEI/ARB + Calcium Channel blocker + Thiazide diuretic + Low does spironolactone

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13
Q

How do ACE inhibitors work?

A

By competitively inhibiting ACE to reduce angiotensin 2 formation

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14
Q

What are the most commonly used ACE inhibitors?

A

Ramipril
Lisinopril
Enalapril

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15
Q

What are the main side effects associated with ACE inhibitors?

A

Dry cough (10-15%)
Hyperkalaemi
Renal failure

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16
Q

How do ARBs work?

A

Bind to angiotensin 1 to prevent conversion to AT2 to prevent aldosterone production and vasoconstriction of renal artery.

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17
Q

Are ARBs well tolerated?

A

Generally, yes. They have few side effects.

18
Q

What are the few side effects of ARBs?

A

Renal failure

Hyperkalaemia

19
Q

What are the commonly used ARBs?

A

Losartan
Valsartan
Candesartan

20
Q

How many classes of calcium channel blockers are there?

21
Q

How do calcium channel blockers work?

A

Bind to specific alpha subunits of L-type calcium channels to reduce cellular calcium entry.

22
Q

What are the three classes of calcium channel blockers?

A
  1. Dihydropyridines
  2. Phenylalkylamines
  3. Benzothiazepines
23
Q

Which calcium channel blockers come under the category of dihydropyridines?

A

Nifedipine

Amlodipine

24
Q

Which calcium channel blockers come under the category of benzthiazepines?

25
Which calcium channel blockers come under the category of phenylalkyamines?
Verapamil
26
What effect do calcium channel blockers have on the body?
- Peripheral vasodilation - Coronary artery vasodilation - Pulmonary artery vasodilation
27
Which calcium channel blockers are good for rate control?
Verapamil | Diltiazem
28
Which calcium channel blockers are good for ischaemic heart disease and heart failure?
Amlodipine | Nifedipine
29
Are amlodipine and nifedipine used in the acute setting?
No as they a large volume of distribution so therapeutic levels take a while to establish
30
Which kind of calcium channel blockers are good for use in heart failure?
Dihydropyridines i.e. amlodipine and nifedipine, as the others can worsen heart failure.
31
How do thiazide diuretics work?
Reduce distal tubular resorption of Na+
32
What are the ADRs associated with thiazide diuretics?
Hypokalaemia Hyperuraemia Impaired glucose tolerance
33
A diabetic patient i started on bendroflumethiazide and atenolol. What is the worry here?
The combination of those 2 drugs can impair glucose tolerance
34
Which condition is a contraindication for thiazide diuretics?
Gout
35
If a pt has angina as well as high blood pressure, what additional drug may be beneficial for both conditions?
Beta blocker
36
Name some beta bockers.
Atenolol Bisoprolol Nebivolol
37
Which condition are beta blockers contraindicated in?
Asthma
38
Other than the commonly used drugs and beta blockers, which other drug classes can lower BP?
Alpha blockers Direct renin inhibitors Centrally acting agents
39
Give and example of an alpha blocker?
Doxazosin
40
In which position do alpha blockers have the most effect on blood pressure?
The upright position i.e. they can cause postural hypotension
41
Which centrally acting agents can lower BP?
- Methylopa - Clonidine - Moxoxidil
42
What is the aetiology of heart failure?
``` IHD HTN Cardiomyopathies Valvular disease Conduction pathway pathology ``` This leads to LV dysfunction