What BPs are classed as hypertension for: \ 80 year olds type 1 diabetics

\ 80 year olds= 150/90 type 1 diabetics= 135/85

5 Hypertension and Heart Failure Flashcards by Catherine Leung

How is hypertension defined? (NICE guidelines)

NICE Hypertension= BP >140/90 mmHg

Elevation in blood pressure that is asssociated with an increase in risk of some harm

Elevated blood pressure that treated will do more good than harm

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What are the different types of hypertension? (4)

Essential/primary/idiopathic
Secondary (to other pathology eg Pheochromocytoma)
Isolated systolic/diastolic
White coat/clinic (elevation of blood pressure whilst at clinic)
1. need to be careful to not overdiagnose

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Outline the best practice for measuring blood pressure?

Patient sat, relaxed, arm supported
Take pressure from both arms
1. If >15mmHg difference between arms, repeat measurement
2. Use arm with higher reading

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What might be classes as a hypertensive emergency? What are the clinical signs?

Hypertensive emergency= BP >180/120 + clinical signs

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What BPs are classed as hypertension for:

<80 year olds
>80 year olds
type 1 diabetics

<80 year olds= 140/90
>80 year olds= 150/90
type 1 diabetics= 135/85

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What are the different stages of hypertension (give BP values)

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What is defined as prehypertension? What lifestyle changes should be recommended to patients who are prehypertensive?

Prehypertension= >120/80 and < 140/90 mmHg

Promotion of regular exercise
Healthy diet
Limit/reduce alcohol intake
Smoking cessation
Reduce dietary sodium
Discourage excessive caffeine consumption

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What are the main therapeutic agents for treating primary hyertension? (4)

ACE inhibitors (Angiotensin converting enzyme inhibitors)
ARBs (Angiotensin receptor blockers
CCBs (Calcium channel blockers)
Diuretics (eg thiazides)

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How do ACE inhibitors aim to reduce blood pressure? (ie what mechanisms)

Limit conversion of Angiotensin I to Angiotensin II

Reduce angiotensin II effects:

Vasodilation
Reduce aldosterone release (increase Na⁺ and H₂O excretion)
Reduce ADH (vasopressin) release (increase H₂O excretion)
Reduce cell growth and proliferation

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Can angiotensin II be produced from angiotensin I independently of ACE?

Yes- by chymases

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Give the names of 2 ACE inhibitors.

naproxen= NSAID

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Explain why a patient may get a dry cough as a result of taking lisinopril or ramipril.

Bradykinin is a substrate for ACE aswell as ACEi.
Use of ACEi potentiates bradykinin
Bradykinin causes vasodilation via NOS/NO and prostacyclin (vasodilator)
Dry cough due to build up of bradykinin

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What are some of the contraindications of ACE inhibitors? (5) Who should they not be given to? (3)

Contraindications

Hypotension
Dry cough
Hyperkalaemia (low aldosterone)
Renal failure (renal artery stenosis)
AKD

Who should we not give ACE inhibitors to?

Patients w./ CKD
Pregnancy
Breastfeeding

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What are some of the important drug interactions with ACEi to note?

Drugs that increase K⁺
NSAIDs
Other antihypertensive agents

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Give 2 examples of angiotensin II receptor blockers (ARBs).

Candesartan
Losartan

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How do ARBs act to reduce BP?

(ARBs= Angiotensin-II blockers= AT₁ Receptor blockers)

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Angiotensin II acts on AT₁ and AT₂ receptors

Directly target AT₁ receptors (more effective at inhibiting Angiotensin II mediated vasoconstriction - chymase production)

Why do ARBs not cause a dry cough or angioedema but ACE inhibitors do?

Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes

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ARBs have no effect on bradykinin

Less effective in low- renin hypertensives

What are some of the contraindications of ARBs inhibitors? (3) Who should they not be given to? (3)

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Contraindications

Hyperkalaemia (low aldosterone)
Renal failure (renal artery stenosis)
AKD

Who should we not give ACE inhibitors to?

Patients w./ CKD
Pregnancy
Breastfeeding

What are some of the important drug interactions with ARBs to note?

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Drugs that increase K⁺
NSAIDs
Other antihypertensive agents

How do CCBs (calcium channel blockers) work to reduce hypertension?

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CCBs- target calcium initiated smooth muscle contraction

Different classes (3) interact with different sites on α1 subunit of VOCC

Outline the mechanism/site of action of the 3 classes of CCBs which are used to treat hypertension:

State the names of drugs in each class
State how they work
Which class is the first line CCB in hypertension
Which drug has selectvity for cerebral vasculature
Which drug is use to treat arrythmia and angina

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What are some of the side effects of dihydropyridines and who should it not be given to (contraindications)?

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Side effects:

Ankle swelling

Flushing

Headaches

Palpitations

Contraindications:

Unstable angina

Severe aortic stenosis

What are the 2 important drug interactions to know for the dihydropyridine class of CCBs?

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Amlodipine + simvastatin - increase effect of statin
Other antihypertensive agents

What are some of the side effects of phenylalkylamines and who should it not be given to (contraindications)?

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Side effects:

Constipation
Bradycardia (iv)
Heart block
Cardiac failure

Contraindications:

Poor left ventricular function
AV nodal conduction delay

What are 3 important drug interactions with phenylalkylamines that we should be aware of?

* β-blockers * Other hypertensives * Other antiarrythmics

Give the name of a thiazide diuretic and a thiazide like diuretic.

Thiazide diuretic: **bendroflumethiazide** Thiazide like diuretic: **indapamide**

What are some of the side effect of thiazides and what are their 2 important drug interactions?

Side effects: * Hypokalaemia * Hyponatraemia * Impaired glucose tolerance * Increased cholesterol and triglyceride levels * Gout * - Increased urea and uric acid levels Interations: * NSAIDs * Potassium lowering drugs

Thiazides are more likely to be chosen to treat hypertension over CCBs if the patient has what sign/symptom?

Oedema

Why are CCBs used in the first instances to treat hypertension in over 55s and those of black African and Caribbean groups?

These populations have low levels of renin in first place- not ideal target system in first instance (RAAS)

Why are ACE inhibitors or ARBs the first line treatment for hypertension secondary to type 2 diabetes irrespective of age or ethnicity?

ACEis and ARBs have added benefits at kidneys * Decrease incidence of diabetic nephropathy and CKD w./proteinuria * Dilation of efferent glomerular arteriole * Reduced intraglomerular pressure

What drugs can be used to treat resistant hypertension (stage 4)? (3) Which of these should be used if blood potassium is \>4.5 mmol/l and if blood potassium is \<4.5 mmol/l?

How does spironolactone work? What are its contraindications (2) and what are its important drug interactions to consider?

**Sprionolactone**= **aldosterone** antoagonist--\> stops action of aldosterone at **ENaC** and also blocks **ROMK** Contraindications: 1. Hyperkalaemia 2. Addison's Interactions: 1. Other K⁺ increasing drugs 2. ACE inhibitors 3. ARBs

Name 3 β-adrenoreceptor blockers (used to treat hypertension) and explain how beta blockers work to reduce blood pressure.

1. **Labetalol** (β1, β2 and α1) 1. Used: preganncy and hypertensive emergencies) 2. **Bisoprolol** (β1) 3. **Metoprolol** (β1) How do they work? * Block noradrenaline * Decrease sympathetic tone * Reduce CO * Reduce release of renin in kidneys (release= partly regulated by β1- adrenoreceptors) * ie REDUCE SYMPATHETIC OUTFLOW

With relation to β-blockers give the: ## Footnote Side effects (5) Contraindications (4) Interactions (1)

Side effects: 1. Bronchospasm 2. Heart block 3. Raynaud's 4. Lethargy 5. Impotence Contraindications: 1. Asthma 2. COPD 3. Haemodynamic instability 4. Hepatic failure Interactions: 1. Non-dihydropyridine CCBs 1. Verapamil 2. Diltiazem

Name 2 α-blocker and describe how they work to treat hypertension. Apart from hypertension what else are they used to treat?

1. **Doxazosin** 2. **Tamsulosin** How does it work? * Selective antagonism- α-1 adrenoreceptors * Reduce peripheral vascular resistance **Tamsulosin** also used to treat symptoms of BPH

State the main contraindications and interactions from α-adrenoreceptor blockers.

Contraindications: * Postural hypotension Interactions: * Dihydropyridien CCBs- oedema

Useful diagram showing neurohormonal response attempting to compensate for hypertension leading to further pathology:

Identify some drugs used to treat and manage heart failure:

Outline the approach to the management of heart failure. (Aims and how is this done)

5 Hypertension and Heart Failure Flashcards

(39 cards)