HTN and Cholesterol Flashcards
Stage 1 HTN defined as a clinic BP of >? and an ambulatory BP monitor daytime average of >?
Clinic BP >140/90
ambulatory BP >135/85
Stage 2 HTN defined as what?
clinic BP >160/100
ambulatory BP >150/95
Stage 3 HTN defined as what?
clinic systolic BP of 180 or more OR
clinic diastolic BP of 110 or more
Normally, you expect BP to dip at night. If there is a difference in daytime and night-time readings of <10% what diagnosis should you explore?
sleep apnoea
what 6 measures of lifestyle intervention should be offered to everyone with HTN?
- diet - high in fruit and veg and low in fat
- regular physical exercise - 30mins moderate aerobic exervcise 5-7 days a week
- reduce alcohol intake
- reduce dietary sodium intake
- smoking cessation
- weight reduction
HTN treatment should be offered to all people <80yrs old with stage 1 HTN and at lease one of which factors (5)
- target organ damage
- CVD
- renal disease
- DM
- 10 yr cardiovascular risk of >20% (lipid lowering therapy is given if 10yr risk >10%)
what is first line treatment of HTN in a patient who is <55yrs old and not of black African or African-carribean origin?
Ace inhibitor
or
ARB
what is first line treatment of HTN in someone over 55yrs or someone from black african or african-carribean family origin
calcium channel blocker
what is first line treatment for a T2DM patient with HTN?
Ace inhibitor or ARB
2nd then 3rd steps for someone <55 and not of black origin for treating HTN?
2nd CCB
3rd thiazide-like diuretic
2nd then 3rd steps for someone >55 or of black origin?
2nd ACE inhibitor or ARB
3rd thiazide-like diuretic
step 4 for everyone with HTN
if blood potassium <4.5 choose low-dose spironolactone
if blood potassium >4.5 choose alpha or beta blocker
Name 5 tests that should be offered to someone with HTN to check for cardiovascular risk and target organ damage
- Urine sample - to get an estimate of the albumin:creatinine ratio to check for protein in the urine
- urine dipstick to test for haematuria
- Blood sample - plasma glucose, electrolytes, eGFR, creatinine, serum total cholesterol and HDL
- examine fundi for presence of hypertensive retinopathy
- 12 lead ECG
what is particularly important to monitor in people taking ACE inhibitors?
eGFR - it should not drop by >25% after taking anti-hypertensives
Name 4 adverse effects of ACE inhibitors
- hypotension (particularly first dose hypotension)
- persistent dry cough
- hyperkalaemia
- they can cause or worsen kidney failure
- Rare = angioedema and anaphylactoid reactions
patients with what 2 conditions should ACEi be avoided in?
- renal artery stenosis
- AKI
- avoid in pregnant/breastfeeding women
What two drugs should be avoided being used alongside ACE inhibitors?
- potassium elevating drugs e.g. K+-sparing diuretics
2. NSAIDs - together they increase risk of nephrotoxicity
When/how often should renal function be tested when starting ACEi?
- before treatment
- 3 months after starting
- then annually
How can you assess CVD risk in people?
QRISK2 risk assessment tool
What percentage 10yr risk does someone need to have to be offered a statin?
10%
what cholesterol-lowering drug should be offered, and at what dose, as primary prevention of CVD?
Atorvastatin 20mg
what dose of atorvastatin should you start for a person with CVD?
80mg
how soon after starting statin treatment should you test cholesterol levels? What percentage of reduction should you ideally have reached?
after 3 months - aim for a greater than 40% reduction in non-HDL cholesterol.
what are the two most common adverse effects to statins?
headache
GI disturbance
