Hypertension Flashcards
What are the 3 stages of hypertension
Stage 1: 140/90-159/99mmHg (clinic) or 135/85-149/94 mmHg (ambulatory)
- drug treatment in patients <80 with kidney disease, diabetes, CVD or 10% risk of CVD in 10 years
-drug treatment + lifestyle advice in patients <60 with <10% risk of CVD in 10 years
- drug treatment in patients >80 with blood pressure over 150/90mmHg
Stage 2: 160/100-180/120mmHg (Clinic) or >150/95mmHg (ambulatory)
-treat all patients
Stage 3: >180/120mmHg
-medical emergency
What is the treatment for hypertension for patients under 55 years old or patients with T2D
Step 1: ace-1 or arb*
Step 2: ace-1 or arb + CCB or TLD (thiazide like diuretic)
Step 3: ace-1 or arb + CCB + TLD
Step 4: if potassium <4.5mmol/l = low dose Spiralactone
If potassium >4.5mmol/l =alpha or beta blocker
*In T2D: ARB is preferred over ACE-i in Astro Caribbean patients
What is the treatment plan for patients over 55 or of Afro-Caribbean origin
Step 1: CCB
Step 2: CCB+ ACE-i/ARB or TLD
Step 3: ACE-i/ARB +CCB +TLD
Step 4: if potassium <4.5mmol/l = low dose Spiralactone
If potassium >4.5mmol/l =alpha or beta blocker
In T2D: ARB is preferred over ACE-i in Astro Caribbean patients
What are ace inhibitors
Ramipril, enalapril lisinopril perindopril
What are the side effects of ace-i
Cough (give arb instead)
Hyperkalemia
Hepatic failure
Aangioedema
Renal impairment
Dizziness or headache
ARBs: candesrtan, irbesartan losartan
Same side effects and interactions as ACE-i apart from cough and angioedema
What are the interaction of ACE-i
Increase of renal failure
-ARBS,k-sparing diuretics, NSAIDs
Increases hyperkalaemia
-Heparins, ARBs, NSAIDS, k-sparing diuretics, beta-blockers
Increase risk of volume depletion
-diuretics
Increases plasma levels of lithium
What are beta blockers
Atenolol, bisoprolol, caredilol, labetalol, propranolol, sotalol, timolol
Cardio selective b-blockers- less likely to cause bronchospasms
- bisoprolol, atenolol, metoprolol, acebutalol, nebivolol (BAtMAN)
Water soluble b-blockers- less likely to cross the BBB- less nightmares
Celiprolol, atenolol, nadolol, sotalol (water CANS)
Intrinsic sympathomimetic b-blockers- less likely to cause cold extreemties
Pindolol, acebutaolol, celiprolol and oxprenolol (ice PACO)
What beta blocker is used for gestational pregnancy
Labetalol
What beta blocker would you give if a patient was asthmatic if they needed a beta blocker
Cardio selective beta blockers
What are the side effects of beta blockers
Bradycardia or heart failure so don’t give amiodarone
Blunts the effects of hypoglycaemia
Can cause hyperglycemia
Bronchospams- contraindicated in asthmatic patients
What are the interactions of beta blockers
Digoxin: can cause heart block
Any other hypotensive drug
What are calcium channel blockers
Dihydropyradine: amlodipine, felodipine, lacidipine, lercandipine, nifedipine
What are the side effects of CCB
Dizziness
Gingival hyperplasia (enlarged gums)
Vasodilators effects (flushing, headaches, ankle swelling): more in duhydropyridine
Complete AV block: more in rate limiting such as verapamil and diltiazem
What is the treatment plan of hypertension in a pregnant patient
Patients are at a high risk of developing pre-eclampsia in :
-kidney disease, diabetes, autoimmune disease and hypertension
Take aspirin from week 12 of pregnancy til birth
If patients has blood pressure greater than 140/90
1st line: labeteolol
2nd line: nifedipine or methyldopa
Aim for blood pressure to be 135/85mmHg
What are the different targets in hypertension
Aged <80: 140/90 (clinical)
Aged <80: 135/85 (ambulatory)
Aged >80: 150/90 (clinical)
Aged >80: 145/85 (ambulatory)
Renal disease: 140/90 (clinical)
Pregnancy: 135/85 (clinical)
T1D: 135/85 (clinical)
