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Flashcards in Hypertension - Treatment Deck (116):
1

What is the first step to diagnose hypertension?

Must use ambulatory blood pressure monitoring (ABPM)

or home blood pressure monitoring (HBPM)

2

What does ABPM stand for?

Ambulatory blood pressure monitoring

3

What does HBPM stand for?

Home blood pressure monitoring

4

What are the different stage of hypertension?

Stage 1

Stage 2

Severe

5

What is stage 1 hypertension?

Clinic blood pressure of 140/90mmHg

ABOM daytime average of 135/85mmHg

6

What is stage 2 hypertension?

Clinic blood pressure of 160/100mmHg

ABPM daytime average of 150/95mmHg

7

What is severe hypertension?

Clinic systolic blood pressure of 180mmHg

or

Diastolic blood pressure os 110mmHg

8

What is the unit of blood pressure?

mmHg

9

What 3 things must be done after diagnosing hypertension?

Assess the risk

Assess end organ damage

Screen for treatable causes

10

What are examples of things that change the risks of having hypertension?

Previous myocardial infarction, stroke ischaemic heart disease

Smoking

Diabetes mellitus

Hypercholesterolemia

Family history

Physical examination

11

What tests can be done to assess end organ damage?

ECG

Echocardiogram

Proteinuria

Renal ultrasound

Renal function

12

What are examples of treatable causes of hypertension that can be screened for?

Renal artery stenosis

Cushing's disease

Conn's syndrome

Sleep apnoea

13

How can people check there own risk?

Using online risk calculators

14

What does the BHS suggest target blood pressure should be?

<135/80-85mmHg

15

When should treatment for high blood pressure start?

Overall cardiovascular disease risk of 20% in the next 10 years

16

Why do we treat hypertension?

Reduces cardiovascular disease by 40-50%

Reduces myocardial infarction by 16-30%

17

By what percentage does treating hypertension reduce risk of cardiovascular disease?

40-50%

18

By what percentage does treating hypertension reduce risk of myocardial infarction?

16-30%

19

How do you describe the approach of treating hypertension?

Stepped approach

20

What does a stepped approach to the treatment of hypertension mean?

Do not continuously change antihypertensive medication

Add new medication to current therapy until the target blood pressure is achieved

21

How kind of doses and number of drugs are used to treat hypertension?

Low doses of several drugs to minimise adverse effects and maximise patient compliance

22

What needs to be remembered about all drugs?

They have side effects

23

How can you describe the renin of young people compared to elderly people?

Young people have high renin whereas elderly have low

24

What kinds of drugs are recommended for use on young people?

ACE inhibitor

Angiotensin II receptor blockers (ARBS)

25

What does ARBs stand for?

Angiotensin II receptor blockers

26

What kind of drugs are recommended for elderly people?

Calcium channel blocker

Thiazide-type diuretic

27

Should treatment always be offered for stage 1 hypertension?

No, only if they are young than 80 and have at least one of the following:

 

Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk greater than 20%

28

When should treatment be offered for stage 1 hypertension?

Young than 80 with at least one of the following:

 

Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk greater than 20%

29

Should treatment always be given for stage 2 hypertension?

Yes

30

Does age impact whether treatment is given for stage 1 hypertension?

Yes, only give treatment if younger than 80

31

Does age impact whether treatment is given for stage 2 hypertension?

No

32

What should you do for people younger than 40 with hypertension?

Seek specialist evaluation of secondary causes and a more detailed assessment of potential target organ damage

33

For what age group is the target blood pressure different?

People over 80

34

What is the target blood pressure for people over 80?

<145/85mmHg

35

How can blood pressure be monitored?

Clinic blood pressure measurements

ABPM (ambulatory blood pressure monitoring) or HBPM (home blood pressure monitoring)

36

How many steps are there in the stepped approach of hypertension treatment?

4

37

What is step 1 treatment for someone over 55?

Calcium channel blocker (CCB)

If CCB unsuitable use thiazide-like diuretic instead

38

Who should a calcium channel blocker (CCB) be offered to as step 1 treatment?

People over 55 and black people

39

Who should an ACE inhibitor not be offered to?

Black people and pregnant woman

40

Why would a calcium channel blocker (CCB) be unsuitable?

Oedema

Intolerance

41

What does CCB stand for?

Calcium channel blocker

42

What is step 2 tratement for hypertension?

Add thiazide-type diuretic such as cloralidone or indapamide to CCB or ACEI/ARB

43

What should be used for step 1 treatment of hypertension for people younger than 55 who are not black?

ACE inhibitor or angiotensin II receptor blocker (ARBs)

44

What is step 3 treatment for hypertension?

Add CCB, ACEI and diuretic together

45

What is step 4 treatment for?

Resistant hypertension

46

What is given for step 4 treatment of hypertension?

Consider further diuretic therapy with low dose spironolactone (25mg once daily) if the blood potassium level is 4.5mmol/L or lower

Consider higher dose thiazide-like diuretic treatment if the blood potassium level is higher than 4.5mmol/L

47

What factor decides what is used for step 4 treatment?

If potassium level is smaller or greater than 4.5mmol/L

48

What should be given for step 4 treatment of hypertension if potasium level is 4.5mmol/L or lower?

Further diuretic therapy with low dose spironolactone (25mg once daily)

49

When should further diuretic therapy with low dose spironolactone be uses as step 4 treatment?

When potassium levels are 4.5mmol/L or lower

50

When should you have caution using further diuretic therapy with lose dose spironolactone treatment even when potassium levels are 4.5mmol/L or less?

With people with a reduced estimated glomerular filtration rate (GFR) because they have an increased risk of hyperkalaemia

51

What does GFR stand for?

Glomerular filtration rate

52

What is hyperkalaemia?

High blood potassium levels

53

What are high blood potassium levels called?

Hyperkalaemia

54

What should be used for step 4 treatment of hypertension when potassium levels are greater than 4.5mmol/L?

Higher dose of thiazide-like diuretic treatment

55

When should a higher dose of thiazide-like treatment be used as step 4 treatment for hypertension?

When potassium levels are greater than 4.5mmol/L

56

What should you do if a single agent doesn't control blood presssure?

Use two together

57

When should you start treatment?

According to age and other pathology if there are no contraindications

58

What does ACEI stand for?

Angiotensin converting enzyme inhibitor

59

What is an example of a angiotensin converting enzyme inhibitor (ACEI)?

Ramipral

60

How does ramipral work?

Competitively inhibits the actions of angiotensin converting enzyme (ACE)

61

What are contraindications of angiotensin converting enzyme inhibitor (ACEI)?

Renal artery stenosis

Renal failure

Hyperkalaemia

62

What are some signs to an adverse drug reaction to angiotensin converting enzyme inhibitors (ACEI)?

Cough

First dose hypotension

Taste disturbance

Renal impairment

Angioneurotic oedema

63

What are some potential drug-drug interactions of angiotensin converting enzyme inhibitors (ACEI)?

NSAIDS

Potassium supplements

Potassium sparing diuretics

64

What does the drug interaction between ACEI and NSAIDS cause?

Precipate acute renal failaure

65

What does the drug interaction between ACEI and potassium supplements cause?

Hyperkalaemia

66

What does the drug interaction between potassium sparing diuretics and ACEI cause?

Hyperkalaemia

67

What are examples of angiotensin II antagonists (ARBs)?

Losartan

Valsartan

Candesartan

Irbesartan

68

How do angiotensin II antagonists work?

Competatively block the actions of angiotensin II at the angiotensin AT1 receptor

69

What is the advantage of ARBs over ACEI?

No cough as a side effect

70

Which of ARBs and ACEI can lead to a cough as a side effect?

ACEI

71

What are examples of calcium channel blockers (CCB)?

Amlodipine/Felodipine

Verapamil/Diatiazem

72

How do CCBs work?

Blocking the L type calcium channels

Selectivity between vascular and cardiac L type channels

Relaxing large and small arteries and reducing peripheral resistance

Reducing cardiac output

73

What CCB is a vasodilator?

Amlodipine/Felodepine

74

What CCB is a rate limiter?

Verapamil/Diatiazem

75

Who are vasodilating CCBs the choice for?

Over 55 years

Woman of child bearing age

76

Why are vasodilating CCBs the choice for people over 55 and woman of child bearing age?

Compliance is high

Benefit in the elderly patient with systolic hypertension

Rarely cause postural hypotension

77

What is postural hypotension?

Person's blood pressure drops abnormally when they stand up after sitting or lying down

78

What is it called when a person's blood pressure drops abnormally when they stand up after sitting or lying down?

Postural hypotension

79

What are contraindications of vasodilating CCBs?

Acute myocardial infarction

Heart failure

80

What is a contraindication of rate limiting CCBs?

Bradycardia

81

What are adverse drug reactions of vasodilating CCBs?

Flushing

Headache

Ankle oedema

Indigestion and reflux oesophagitis

82

What are adverse drug reactions of rate limiting CCBs?

Bradycardia

Constipation

83

What are examples of thiazide-like diuretics?

Indapamide

Clortalidone

84

What is the mechanism of action of thiazide-like diuretics?

Excretion of sodium through urine

85

What are some adverse drug reactions of thiazide-like diuretics?

Not common but includes:

 

Gout
Impotence

86

What is gout?

Form of arthritis caused by excess uric acid in the bloodstream

87

What is a form of arthritis caused by excess uric acid in the bloodstream?

Gout

88

What is impotence?

Inability of a man to achieve an erection or orgasm

89

What is the inability of a man to achieve an erection of orgasm called?

Impotence

90

What is a key advantage of thiazide-like diuretics?

Can be used with an other antihypertensive agent

91

What do thiazide-like diuretics have a proven benefit in?

Stroke and myocardial infarction reduction

92

What are some less commonly used agents used to treat hypertension?

Alpha-adrenoceptor antagonist

Centrally acting agents

Vasodilators

93

What is an example of an alpha-adrenoceptor antagonist?

Doxazosin

94

How do alpha-adrenoceptor antagonists work?

Selectively block post synaptic A1 adrenoceptors and oppose vascular smooth muscle contraction in arteries

95

What are some adverse drug reactions of alpha-adrenoceptor antagonists?

First dose hypotension

Dizziness

Dry mouth

Headache

96

What are some examples of centrally acting agents?

Methyldopa

Moxonidine

97

How do centrally acting agents work?

Converted to a-methylnoradrenaline which acts on the CNS alpha adrenoceptors which decrease central sympathetic outflow

98

What are some adverse drug reactions of centrally acting agents?

Sedation and drowsiness

Dry mouth and nasal congestion

Orthostatic hypotension

99

What is orthostatic hypotension?

Decrease in systolic blood pressure of 20mmHg or a decreased in diastolic blood pressure of 10mmHg within 3 minutes of standing up

100

What is a decrease in systolic blood pressure of 20mmHg or a decreased in diastolic blood pressure of 10mmHg within 3 minutes of standing up called?

Orthostatic hypotension

101

What are examples of vasodilators?

Hydralazine

Minoxidil

102

What is the common treatment regimen for someone over 55?

1) Start CCB

2) If no or incomplete effect add thiazide-type diuretic

3) If incomplete effect add ACE inhibitor

4) If incomplete effect add beta blocker

5) If incomplete effect add one of the less commonly used agents

6) No change after this is likely due to non-compliance

103

What is a common treatment regimen for someone younger than 55?

1) Start ACEI, if woman of child bearing age use CCB or beta blocker

2) If no or incomplete effect add thiazide-like diuretic

3) If incomplete effect add CCB

4) If incomplete effect add beta blocker

5) If incomplete effect add a less commonly used agent

104

If there is still no change at the final step of treatment what is it likely due to?

Non-compliance

105

What cause of maternal and featal death is hypertension?

Second most common

106

What do 30% of woman who have hypertension during pregnancy develop?

Preeclampsia

107

What is preeclampsia?

Pregnancy complication characterised by high blood pressure and signs of damage to another organ system, most often the liver and kidneys

108

What organ systems are most often damaged due to preeclampsia?

Liver and kidneys

109

What is a pregnancy complication characterised by high blood pressure and signs of damage to another organ system called?

Preeclampsia

110

Other than preeclampsia, what other conditions can hypertensive pregnancy woman get?

Chronic hypertension

Gestational hypertension

111

What is gestational hypertension?

Blood pressure higher than 140/90mmHg measured on two seperate occastions more than 6 hours apart without the presence of protein in the urine and diagnosed after 20 weeks gestation

112

What should happen to blood pressure during a normal pregnancy?

It should fall

113

What happens to blood pressure in a pregnant woman with existing hypertension?

Sometimes blood pressure rises and patient develops hypertension during pregnancy (gestational hypertension)

Sometimes blood pressure rises severely from about 20 weeks to greater than 140/90mmHg and proteinuria more than 300mg/24 hours (preeclampsia)

114

What is used for the treatment of hypertension during pregnancy?

Nifedipine MR, methyldopa, atenolol, labetalol

Then add thiazide diuretic and/or amlodipine

115

What medication should never be used for hypertension during pregnancy?

ACE or ARB

116

What difference is there between the treatment of hypertension during pregnancy and the treatment of preeclampsia?

Normal treatment plus intravenous hydralazine, esmolol and labetalol

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