Hypertension Flashcards
(53 cards)
1
Q
What is the formula that described the pathophysiology of hypertension?
A
BP = CO x PR
2
Q
What parameter do diuretics act on?
A
- diuretics act on CO (cardiac output)
3
Q
What are some of the main complications of HTN?
A
- cerebrovascular disease
- coronary artery disease
- congestive heart failure
- renal failure
- peripheral vascular disease
- dementia
- atrial fibrillation
- erectile dysfunction
4
Q
What are the 2 highest risk factors for having a cardiovascular event?
A
- smoking
- diabetes
5
Q
What should the hypertension goals be?
A
- 140/90
6
Q
Describe the sprint trial?
A
- a randomized trial of intensive vs standard blood pressure control
- left sided heart failure or stroke patients are not included in the study
- they did both an intensive (<120) vs standard (<140) BP control
- trying to push the blood pressure levels to being under 120 systolic - can lead to serious adverse events (life threatening permanent disability, hospitalization)
7
Q
What other factors are important to consider when looking to manage blood pressure?
A
- diet
- if he is a smoker
- exercise habits
- stress level
- familial history of cardiac events
- any allergies
8
Q
What are some of the major drug causes of high blood pressure?
A
- NSAIDs
- decongestants
- alcohol
- estrogen
- some herbal supplements**
9
Q
How long do non drug measures usually take to take effect?
A
- 3-6 months until non drug measures take effect
10
Q
What are some of the non drug interventions to lower blood pressure?
A
- watch salt intake and diet
- watch fat content in food
- stress management
- DASH diet
- aerobic exercise
- weight reduction (BMI should be between 18.5-24.9)
- moderation of alcohol intake
- caffeine reduction
11
Q
What should the sodium level be at for optimal blood pressure control?
A
2,000 mg
12
Q
What are the main mechanisms in which blood pressure is reduced?
A
- reduction of contractility with minimized vasoconstriction
- reduction of peripheral resistance
13
Q
What are the effects of calcium channel blockers vs thiazides vs ACE inhibitors in lowering blood pressure?
A
- all have about the same effect in how they lower blood pressure
- all are quite similar on their effects on mortality
14
Q
Why is it important to not give ACE inhibitors to someone that is also taking an NSAID?
A
- ACE inhibitors vasodilate the efferent arterioles coming out of the glomerulus, while NSAIDs are vasoconstricting the afferent arterioles that are coming into the kidneys - turns it into a “dripping tap”
15
Q
What are the common ADRs when using thiazides?
A
- dizziness, increased urination, increased sensitivity to sun, muscle cramps, biochemical abnormalities (decreased K, Na, increased lipids, increased uric acid and glucose)
16
Q
What are the cautions to keep in mind with thiazides?
A
- watch in gout, hypokalemia and hyponatremia
17
Q
What are the common ADRs for ACE inhibitors?
A
- dry cough, increased K and increased serum creatinine
- increase in over 30% is a concern in SCr
18
Q
What are the cautions to keep in mind with ACE inhibitors?
A
- history of bilateral renal artery stenosis, NSAID use
19
Q
What are the common ADRs to keep in mind with ARBs?
A
- increased K and increased serum creatinine
20
Q
What are the cautions to keep in mind with ARBs?
A
- history of bilateral renal artery stenosis, NSAID use
21
Q
What are the ADRs associated with beta blockers?
A
- cold extremities, fatigue, nausea, decreased HR, decreased exercise tolerance, vivid dreams and impotence
22
Q
What are the cautions associated with beta blockers?
A
- history of asthma, severe PAD, heart block, age over 60
23
Q
What are the main ADRs associated with DHP calcium channel blockers?
A
- flushing, ankle edema, headache, increased HR
24
Q
What are the main ADRs associated with non DHP CCBs?
A
- decreased HR, flushing, edema, headache, heart block, worsened HF, constipation
25
As a general rule for anti hypertension medications, using _______ will lead to only 20% less blood pressure reduction
1/2 of the standard doses
26
What was the effect that was found when studying the effects of beta blockers in treating hypertension alone?
- BB reduction vs placebo:
--- <60 y/o: better
--- >60 y/o: similar to placebo
(vs other antihypertensives it even caused MORE CV events such as stoke in those over 60)
27
What is the dosing frequency of thiazide diuretics? What other considerations must be taken into account?
dose OD
- less effective id ClCr is <30 mL/min
- chlorthalidone comes in 50 mg or 100 mg tabs
28
What is the dosing frequency of ACE inhibitors?
OD or BID
29
What other considerations must be taken into account when giving ACE inhibitors/ARBs/beta blockers?
may be less effective in black patients
30
What interactions must be kept in mind when dosing calcium channel blockers?
- CYP 3A4 interactions
31
What lab value would you look at to when assessing kidney function in a patient having newly started a medication? What is norma; for this value?
urinary albumin/creatinine ratio
| - anything under 2.0 is normal
32
Why might the urinary albumin/creatinine ratio be high?
- albumin is a large molecule - proteins of this size should not be able to get into the urine and into the bladder
- when we are peeing out large amounts of albumin compared to creatinine, then that means that the kidneys are starting to get a little leaky
33
What are the effects of a SBP under 120 vs under 140?
- 0.2% reduction in stroke, 0.4% increase in significant adverse effects
34
What is the effect of aiming for a SBP target of <140 in those with diabetes mellitus?
if systolic blood pressure is less than 140 mm Hg, then further treatment is associated with increased risk of cardiovascular death with NO observed benefit
35
What is the drug recommendation for those with cardiovascular or kidney disease (including microalbuminuria) or with CVD risk factors in addition to diabetes or hypertension?
- an ACE inhibitor
| - an ARB-- these are both recommended as initial therapy
36
For people with diabetes and hypertension WITHOUT cardiovascular or kidney disease, what is the recommendation for drugs to tx hypertension?
- ACE inhibitors
- ARBs
- dihydropyridine CCBs
- thiazide/thiazide like diuretics
(give NO difference in the incidence of end stage renal disease between the options)
- no difference in CHD, stroke or CVD
37
what is the only drug that can be used to recede the incidence of microalbuminuria in diabetes?
ACEIs or ARBs
| these reduce the progression of nephropathy to ESRD
38
What its the main blood pressure target that we should be aiming for?
- 140/85-90
39
FOR THOSE WITHOUT KINDEY DISEASE, ACE AND ARB DO WHAT?
- they reduce the liklihood of developing microalbuminuria, but nor doubling of SCr or ESRD
40
FOR THOSE WITH DIABETIC KIDNEY DISEASE WHAT DO ACE AND ARBS DO?
both delay the progression of nephropathy to ESRD
41
Using half standard doses of blood pressure medications results in what?
- 20% less bp reduction
42
What happens when you add 2 separate blood pressure medications together?
- you stack the effects, but do not stack the AE
| - -- this is a very good thing!
43
Generally, when should blood pressure medications be taken?
using antihypertensive medications at bedtime reduces the incidence of CV events more than use of all drugs in the morning
44
What are the risks of treating hypertension in the elderly?
- increased orthostatic hypotension
- increased morbidity and increased risk of falls
(they are more sensitive to sympathetic inhibition and volume depletion)
45
Elderly aged > 85 years old with a systolic bp <120 are associated with what?
with increased mortality
46
Elderly aged ~70 with a diastolic bp (<65) is associated with what?
associated with increased stroke and CV event risk
47
Isolated systolic HTN and wide pulse pressures are associated with what in the elderly?
increased risk of MI, stroke and renal failure
48
What is the target blood pressure in the very elderly with comorbid conditions?
BP <150/80
49
What was the effect of BP reduction to <150/80?
- 3% decrease over 2 years of CV events
| - 2.2% decrease in mortality
50
What is a good starting medication to use in the elderly?
- thiazide
51
Compare chlorthalidone vs HCTZ?
- chlorthalidone has longer DOA and is more potent than HCTZ
| - chlorthalidone has better BP reduction vs HCTZ
52
Are all thiazides created equal?
- NO
| - chlorthalidone and indapamide are likely superior to HCTZ in reducing BP and improving clinical outcomes
53
What consideration needs to be given when treating hypertension after a stroke?
- strong consideration needs to be given after the initiation of an antihypertensive therapy after the acute phase of a stroke or TIA (patient needs the blood flow to the brain to perfuse their brain)
- following the acute phase of a stroke, blood pressure lowering treatment is recommended to a target of consistently lower than 140/90 mmHg
- treatment with an ACEI and diuretic combination is preferred
- -- do NOT combine ACE and ARB in stroke patients
