Hypertension Flashcards
(27 cards)
2mmHg rise in systolic associated with what increased % mortality?
Heart disease
Stroke
7% heart disease
10% stroke
3 goals of HT treatment
reduce arterial BP to recommended targets
reduce risk of end organ damage
reduce risk of mortality due to CVD
when are anti-HT drugs indicated
- stage 2 or 3
- stage 1 with one or more of:
- target organ damage
- established CVD
- renal disease
- diabetes
- a 10 year CV risk equivalent to 10% or greater
3 CV risk estimators
ASSIGN
Qrisk
JB53
blood pressure targets for standard patients vs over 80 y/o
<140/90
<150/90
an increase in BP is possible with which types of drugs?
NSAIDS (ibruprofen, diclofenac) Oral steroids (prednisolone) Venlafaxine (anti-depressant) Illicit drug use Decongestant (eg. sudafed) Soluble/dispersible drugs that contain SALT
describe the steps of anti-HT prescribing
Step 1: ACEI OR ARB (if age <55 and not black)
CCB if over 55 or black
Step 2: ACEI/ARB + CCB OR THIAZIDE DIURETIC
Step 3: ACEI or ARB + CCB + Thiazide diuretic
Step 4: low-dose spironolactone (if K level <4.5)
alpha/beta blocker if blood K >4.5mmol/l
In normal patients - what do we think for anti-HT drug progression?
A CEI/ARB
C calcium channel blocker
D iuretic
C (call for help!! resistant hypertension)
Examples of ACEI
ramipril, lisinopril, captopril
ARBs examples
losartan, candesartan, irbesartan
examples of
rate limiting calcium channel blockers
dihydropyridine
verapamil, diltiazem
amlodipine, felodipine, lercanidipine
what are the two types of diuretics
thiazide-like (often essential at step 2/3, but not effectiv in moderate-severe renal impairment)
high dose loop diuretics can be used for raised BP inrenal failure
example of thiazide like diuretics
indapamide
bendroflumethiazide
Step 2 anti-HT required, but patient has moderate renal impairment - what do you give them?
furosemide (high dose loop)
what do ARBs act on?
angiotensin 2 AT1 subtype receptor antagonists
eg. losartan
4 things that activate renin release
- renal sympathetic activity
- decreased renal perfusion pressure
- glomerular filtration
- beta-agonists PG I2
3 actions of angiotensin 2 at AT1 receptors
- Vascular growth (hyperplasia, hypertrophy)
- Vasoconstriction (direct or via increased noradrenaline released from sympathetic n)
- salt retention (aldosterone secretion, tubular Na reabsorption)
what’s the cheeky additional benefit of RAS inhibitors?
what does this therefore mean?
renal protection (if used cautiously!) they are the recommended first line in people with HT AND type 2 diabetes (to reduce progression of diabetes-related nephropathy)
common side effects of ACEI
dry cough, dizziness, tiredness, headaches
slight increased risk of angioedema if African/caribbean ethnicity
risk of HYPERKALAEMIA
renal impairment - must monitor
common side effects of ARBs
dizziness, headaches, back/leg pain
risk of HYPERKALAEMIA
renal impairment
ACEI/ARB contraindications
allergy, hypersensitivity
history of angioneurotic oedema
significant bilateral renal artery stenosis or renal artery stenosis in single functioning kidney
pregnancy
action of normal Ca channel blockers
block entry of ca through slow channels in cardiac and smooth muscle
= reduce cardiac output
Class 4 anti-arrythmics - verapamil, diltiazem
peripheral vasodilation, reduced TPR
what makes the Ca channel blockers used in hypertension special
they are DIHYDROPYRIDINE-like CCBS:
they have less effect on cardiac muscle cells, greater impact on vascular smooth muscle = reduces PR.
eg. amlodipine, felodipine, lercanidipine
Contra-indication of dihydropyridine like CCBs
uncontrolled HF cardiogenic shock significant aortic stenosis unstable angina pregnancy (but consider risk/benefit)
