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CVS block > Hypertension 2 > Flashcards

Hypertension 2 Flashcards

1
Q

How do you assess end organ damage?

A
  • ECG
  • Echocardiogram
  • Proteinuria
  • Renal ultrasound
  • Renal function
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2
Q

What treatable causes do you screen for?

A
  • Obesity
  • Renal artery stenosis/Fibromuscular dysplasia
  • Endocrine causes
  • Coarctation of aorta
  • Drug induced
  • Sleep apnoea
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3
Q

What is stage 1 hypertension treatment for people <80 years?

A

Offer antihypertensive drug treatment to people <80 years with one or more of the following:
- Target end organ damage

  • Established cardiovascular disease
  • Renal disease
  • Diabetes
  • 10 year CV risk 10% or greater
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4
Q

What is the stage 1 hypertension treatment in <40 patients?

A

Seek specialist evaluation for secondary causes of hypertension and a more detailed assessment of potiential end organ damage

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5
Q

What is the stage 1 hypertension treatment for age 55-80?

A

Offer the same antihypertensive drug treatment as age 55-80 (taking into account any co-morbidieties) but BP target of 145/85

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6
Q

What is stage 2 hypertension treatment?

A

Offer antihypertensive drug treatment to people of any age with stage 2 hypertension

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7
Q

What is step 1 of choosing antihypertensive drug treatment in patients aged over 55 or Black people?

A

Start a calcium channel blocker or a thiazide like diuretic

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8
Q

What is step 1 of choosing antihypertensive drug treatment in patients aged under 55?

A
  • Offer ACE inhibitor or ARB
  • Not african or caribbean - less effective and higher risk of angioedema
  • Women of child bearing age - teratogenic in early stages and fetal toxic in later stages.
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9
Q

What is the step 2 of choosing antihypertensive drug treatment?

A

Add thiazide type diuretic to step 1 e.g indapamide

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10
Q

What is step 3 of choosing antihypertensive drug treatment?

A

Add CCB, ACEi and diuretic together

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11
Q

What is step 4 of choosing antihypertensive drug treatment?

A

Resistant hypertension

Unable to achieve target BP despite 3 or more agents
- Consider compliance issues

  • Consider higher dose thiazide like diuretic therapy (if k +>4.5)
  • Consider further diuretic therapy: low dose spironolactone
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12
Q

Antihypertensive drugs?

A

Angiotensin converting enzyme inhibitors : Rampril, perindropril

Competitively inhibit the action of ACE

ACE converts angiotensin I to active angiotensin II which is a potent vasoconstrictor

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13
Q

Who should ACEi not be used on?

A
  • Renal artery stenosis: may precipitate renal failure or renal infarction
  • Impaired renal function
  • Hyperkalaemia
  • Fertile female
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14
Q

What are the drug-drug interactions?

A
  • NSAIDs: precipitate acute renal failure
  • Potassium supplements/potassium sparing diuretics - Hyperkalaemia
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15
Q

What are examples of angiotensin II receptor blockers?

A

Losartan, valsartan and candesartan

  • ARBs competitively inhibit the action of angiotensin II at the angiotensin AT1 receptor
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16
Q

What are the advantages of ACEi?

A

Fewer side effects

17
Q

Calcium channel blockers (CCB)

A

Vasodilators
- Eg amlodipine, felodipine
- Reduce peripheral vascular resistance
- Age >55
- Women of child bearing age (nifedapine)

Rate limiting Ca2+ blockers
- Eg Verapamil
- Reduce HR and produce some vasodilation

They both block the L type calcium channel in the myocytes of the vasculature and heart

18
Q

What are the adverse drug reactions of calcium channel blockers?

A
  • Flushing
  • Headache
  • Ankle oedema
  • Indigestion/reflux

Rate limiting agents also cause
- Bradycardia
- Constipation

19
Q

Why should calcium channel blockers not be used?

A
  • Acute Mi
  • Heart failure
  • Bradycardia (rate limiting CCBs)
20
Q

Thiazide type diuretics

A

Eg Indapamide

  • Commonly first line therapy in mild-mod hypertension in people of african/caribbean origin
  • Can be used in combination with any other anti-hypertensive
  • Proven benefit in reducing risk of stroke & myocardial infarction
  • Low doses that dont cause significant diuresis
21
Q

What is the mechanism of action of thiazide type diuretics?

A
  • Enhance urinary excretion of sodium
  • Resistance vessel dilation - reduce peripheral vascular resistance
  • Full antihypertensive effect may take weeks
  • Adverse drug reactions are not common but include gout and ED
22
Q

What are the less commonly used agents?

A

Alpha adrenoceptor antagonist

Centrally acting agents

Vasodilators: Hydralazine and minoxidil

23
Q

What are centrally acting agents?

A

Methyldopa and moxonidine

  • Methyldopa is used in hypertension in pregnancy
  • Adverse effects : Sedation, drowsiness, dry mouth and orthostatic hypotension
24
Q

What are alpha adrenoceptor antagonist?

A

Doxazosin

  • Opposes vascular smooth muscle contraction in the arteries
  • Adverse effects: 1st dose hypotension, dizziness, dry mouth headache
25
Q

What is the common treatment regimes for age >55 or african/caribbean orIgin?

A
  • Start CCB
  • Add thiazide diuretic
  • Add ACEi/ARB
  • Add beta blocker or alpha blocker (bisoprolol or doxazosin)
  • Add less commonly used agent
26
Q

What are the common treatment regime for age <55?

A
  • Start ACEi
  • Add thiazide diuretic
  • Add CCB
  • Add beta blocker
  • Add less commonly used agent

CVS block (17 decks)

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