Tutorial 16 - Hypertension Flashcards
What is hypertension?
Persistently raised blood pressure.
What is the difference between primary and secondary hypertension?
- Primary - No identifiable cause - most common (90%).
- Secondary - Known cause - renal/endocrine/vascular cause.
How can hypertension be staged?
- Stage 1 - Rangeing from 140/90 to 159/99
- Stage 2 - Rangeing from 160/100 to 179/119
- Stage 3 - Above 180/120
What are the risk factors for hypertension?
- Increasing age
- Co - existing co-morbidities - diabetes or CKD.
- Lifestyle choices - smoking, alcohol, high salt diet.
What are the possible complications of hypertension?
- Heart failure (left ventricular hypertrophy and consequent failure).
- Coronary heart disease and MI
- CKD
- Stroke
- Peripheral arterial disease
- Vascular dementia
What is 1st line for patient below the age of 55,non afro carribean ethnicity and potentially have type 2 diabetes?
- ACEI -ramipril
- ARB - Candesartan
What is 1st line for a patient who is over the age of 55 or are black/Caribbean ethnicity?
How do ACEI and ARB’S work?
- They both ultimately work to decrease blood pressure by blocking the vasodilative and aldosterone secreting effects of AT2.
- ACEI - Block ACE
- ARBS- Block eeffect of AT2 at AT1 receptor.
What are the possible side effects of ACEI/ARB’s?
- Hypotension
- Hyperkalaemia (muscle weakness,)
- Cough
- Angioedema
- Renal detoriation
Contraindications for prescription of ACEI/ARB’As.
- Angioedema
- Renal disease i.e., renal artery stenosis.
What is 1st line for a person over 55 and affro carribean ethnicity.
- CCB - amlodipine
How does amlodipine work.
- Relaxes muscles around blood vessels and thereby increases its diameter - decreasing the blood pressure.
What are the possible side effects of amlodipine?
- Peipheral oedema
- Tachcardyia
- flushing
What are the contraindications for amlodipine?
- Cardiogenic shock
What is done after these drug treatments?
- Mix and match ACEI with CCB
- Introduce thiazide like diuretics
- Introduce alpha blocker (ideal if they also have an enlarged prostate), beta blocker(ideal if they also have anxiety) or spironolactone.