management and treatment Flashcards
(26 cards)
target clinical blood pressure for
1) <80 y/o with treated hypertension
2) ≥80 y/o with treated hypertension
1) below 140/90
2) below 150/90
target AMPB or HBPM for
1) <80 y/o with treated hypertension
2) ≥80 y/o with treated hypertension
target average blood pressure of during the person’s waking hours of:
1) <135/85
2) <145/85
how should the treatment offered differ between someone with isolated systolic hypertension and someone with raised systolic AND diastolic BP?
they should be given the same treatment
what 2 drugs should you never combine to treater hypertension?
an ACE inhibitor and an ARB
True or false: people aged 80 years and over should be offered the same antihypertensive drug treatment as people aged 55–80 years
true (taking into account any comorbidities)
first step for hypertension treatment in a <55
ACEI or low-cost ARB (angiotensin II receptor blocker)
first step for hypertension treatment in a >55 / black person of African or Caribbean family origin of any age with hypertension
calcium-channel blocker
step 2 for treating hypertension (irregardless of age/ colour)
ACEI or ARB + calcium channel blocker
step 3 for treating hypertension (irregardless of age/ colour)
ACEI or ARB + calcium channel blocker + thiazide-like diuretic (each taken once daily)
at which stage in the NICE treatment plan for hypertension are you treating resistant hypertension?
stage 4
give an example of a thiazide-like diuretic
chlortalidone
What is resistant hypertension?
clinic blood pressure that remains higher than 140/90 mmHg after treatment with the optimal or best tolerated doses of an ACE inhibitor or an ARB plus a CCB plus a diuretic
In what case may an ARB be offered over an ACEI?
If the patient found the dry cough produced as a side effect of ACEI intolerable
True or false: Beta-blockers are a preferred initial therapy for hypertension.
false - beta-blockers are NOT a preferred initial therapy for hypertension (but may be considered in same situations)
In what situation would the use of beta-blockers in treatment of hypertension be considered?
It may be considered in younger people, particularly:
- those with an intolerance or contraindication to ACE inhibitors and angiotensin II receptor antagonists or
- women of child-bearing potential or
- people with evidence of increased sympathetic drive.
A calcium channel blocker (CCB) is the first stage treatment for >55s or black patients from African or Caribbean family origin of any age with hypertension. What would be alternatively prescribed if this was not suitable? and why might it not be suitable to prescribe this to a patient?
If a CCB is not suitable, for example because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.
If therapy is initiated with a beta-blocker and a second drug is required, what should you add instead of a thiazide-like diuretic and why?
a CCB
to reduce the person’s risk of developing diabetes.
downside to measuring BP in clinic?
it can lead to white coat hypertension
how might the effects of white coat hypertension be avoided so as to better predict the actual BP of the patient
offer ABPM or HBPM
patients with sustained BP are subdivided into which 2 groups?
stage 1 and stage 2 hypertension
define stage 1 and stage 2 hypertension
??
what AMBP and HBPM recordings would diagnose
1) stage 1 hypertension
2) stage 2 hypertension
1) ABPM daytime average and HBPM average of 135/85
2) ABPM daytime average and HBPM average of 150/95
what ECG features would suggest ischaemia or previous infarct
pathological Q wave, left bundle branch block
when a patient present with angina what should be done in terms of blood tests? (ideally initial blood tests should be done within a day of presentation)
a full blood count to exclude anaemia, renal function,
fasting blood glucose and fasting lipid profile.
