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Flashcards in Hypertension Therapy Deck (80)
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1

What do you need to identify before starting hypertension treatment?

True hypertension (from white coat hypertension) - use ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM)

2

What should be looked for and included in assessing risk of hypertension?

Previous MI, stroke or IHD
Smoking
Diabetes mellitus
Hypercholesterolaemia
Family history

3

What tests should be done to assess for potential end organ damage from hypertension?

ECG for LVH
Echocardiogram for LVH
Urine albumin to creatinine ratio for proteinuria
Renal ultrasound for kidney damage
eGFR for kidney function

4

What treatable causes of hypertension should be screened for?

Renal artery stenosis
Cushing's disease
Conn's syndrome
Sleep apnoea

5

What tools are available for risk assessment of hypertension?

Assign Risk Calculator
Q Risk

6

What does the BHS suggest as a target BP for hypertension treatment?

< 135/85mmHg

7

When should treatment of hypertension be started?

When overall CVD risk is 20%/10 years

8

What are the main reasons for treating hypertension?

Reduce cerebrovascular disease by 40-50%
Reduce MI by 16-30%

9

What is the treatment approach used for hypertension?

Stepped approach - do not continuously change medication, add new medication to current therapy until target BP is achieved
Low doses of several drugs

10

When should antihypertensive drug treatment be offered to people under 80 years old with ABPM > 135/85?

When they have one or more of;
Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk equivalent to 20% or greater

11

When should people with stage 2 hypertension be offered antihypertensive drug treatment?

Antihypertensive drug treatment should be offered to people of any age with stage 2 hypertension

12

When is specialist evaluation necessary in hypertension?

For people aged under 40 years with stage 1 hypertension or greater - evaluation of secondary causes and a more detailed assessment of potential target organ damage is necessary

13

What should be the approach to antihypertensive drug treatment in people over 80 years old?

Offer the same antihypertensive drug treatment as people aged 55-80, but take into account any co-morbidities
Blood pressure target will be different at 145/85mmHg

14

What should be the approach to treatment of white coat hypertension?

Consider ABPM or HBPM as an adjunct to clinical blood pressure measurements to monitor the response to antihypertensive treatment with lifestyle modification or drugs

15

What is stage 1 treatment of hypertension for people aged over 55 years?

Offer calcium channel blocker
If not suitable offer thiazide like diuretic

16

What is stage 1 treatment of hypertension for black people of African or Caribbean family origin of any age?

Offer calcium channel blocker
If not suitable offer thiazide like diuretic

17

When might a calcium channel blocker not be suitable?

Oedema
Intolerance
Evidence of heart failure

18

What is stage 1 treatment of hypertension for people under 55 years?

ACEI or ARB
These should not be offered to people of African or Caribbean family origin or to women of child-bearing age

19

What is step 2 treatment of hypertension?

Add a thiazide like diuretic to the existing CCB, ACEI or ARB

20

What is step 3 treatment of hypertension?

Combine CCB, ACE/ARB and thiazide like diuretic

21

What is step 4 treatment of hypertension?

Treatment of resistant hypertension
Consider further diuretic therapy with low-dose spironolactone if blood potassium level is 4.5mmol/l or lower
Consider high-dose thiazide-like diuretic if blood potassium level is higher than 4.5mmol/l

22

When might an ACEI and ARB both be used?

In young people where one is not sufficient in controlling BP

23

Give an example of an angiotensin converting enzyme inhibitor

Ramipril
Perindopril

24

How do ACEIs work?

Competitively inhibit the actions of angiotensin converting enzyme
Interfere with pathophysiology of coronary ischaemia and renal insufficiency through blockade of the renin-angiotensin system

25

What is the function of angiotensin converting enzyme?

Converts angiotensin I to active angiotensin II

26

What is the function of angiotensin II?

Potent vasoconstrictor and hypertrophic agent - plays a central role in organ damage

27

What are the contraindications to ACEI use?

Renal artery stenosis
Renal failure
Hyperkalaemia

28

What are the possible adverse drug reactions from ACEI use?

Cough
First dose hypotension
Taste disturbance
Renal impairment
Angioneurotic oedema

29

What are the potential drug-drug interactions from ACEI use?

NSAIDs - precipitate acute renal failure
Potassium supplements - hyperkalaemia
Potassium sparing diuretics - hyperkalaemia

30

Give an example of an angiotensin II antagonist

Losartan
Valsartan
Candesartan
Irbesartan