Treatment of hypertension Flashcards
(47 cards)
Why do we need to identify true hypertension ?
Because the normal day to day variation in BP we need 20-30 clinic readings to be certain of true BP
Must use ABPM or HBPM
What are the risk factors we need to assess ?
Previous stroke, MI, IHD Smoking Diabetes mellitus Hypercholesterolaemia Family history Physical examination
What investigations are used for end organ damage ?
ECHO/ECG- LVH
Urine analysis- proteinuria
renal ultrasound
renal function
What treatable causes would we screen for ?
Obesity Renal artery stenosis/ FMD Conn's, Cushing's, Pheochromocytoma Coarctation Drug induced Sleep apnoea
What risk assessment tools can be used to quantify risk ?
Assign risk calculator/ Q-risk
What are the reasons for treating hypertension ?
Reduce cerebrovascular disease
Reduce MI by 16-30%
How do we treat hypertesnion ?
Stepped approach
Use low doses of several; drugs
This approach minimises adverse events and maximises pateint compliance
What is the treatment of hypertension un <55yrs ?
ACEI/ ARB
Beta-blocker
What is the treatment of hypertension in >55yrs or afro-Caribbean ?
Calcium channel blocker
Thiazide- type diuretic
What is the treatment of stage 1 hypertension ?
Offer antihypertensive drug treatment to people ages under 80 years with ABPM >135/85 with one or more of the following:
- target organ damage - established cardiovascular disease - renal disease - diabetes - a 10yr cardiovascular risk equivalent to 10% or greater
What is the treatment for stage 2 hypertension ?
Offer antihypertensive drug treatment to people of any age with stage 2 hypertension
What is the treatment for people <40yrs with stage 1 hypertension ?
Seek specialist evaluation of secondary causes of hypertension
More detailed assessment of potential target organ damage
What is the treatment of the elderly pateint ?
Offer people aged 80ys or above the same antihypertensive drug treatment as people ages 55-80 years, taking into account any co-morbidities
BP target is different in the pateints >80yrs
<145/85
How should we choose the right antihypertensive drug ?
Step 1 treatment in those people ages over 55yrs and black people of any age:
- start treatment with: - calcium channel blocker - thiazide like diuretic
What is step 1 treatment ?
Patient under 55 years offer ACE/ARB
Not:
- African or Caribbean- less effective and higher risk of angioedema
- women of child bearing age- teratogenic
What is step 2 treatment ?
Add thiazide-type diuretic such as indapamide to CCB or ACEI/ARB
What is step 3 treatment ?
Add CCB, ACEI, diuretic toghether
What is the treatment of resistant hypertension ?
Step 4 treatment
What is step 4 treatment ?
Consider compliance issues
Consider higher-dose thiazide-like diuretic treatment if the blood potassium level is higher than 4.5mmol/l
Consider further diuretic therapy with low-dose spironolactone 25mg once daily) if blood
potassium level is <4.5mmol/l
If there are no contraindications should we start treatment for resistant hypertension ?
Yes, start treatment according to age and other pathology
If over 55 years:
- a CCB or thiazide-like diuretic
Dont use max dose as side effects more common
For resistant hypertension, what should we use if pateint is young and male ?
An ACEI or ARB
If single agent doesn’t control BP, then add a second agent
What does ACE inhibitors do ?
Completely inhibit the actions of angiotensin converting enzymes- ACE
ACE converts angiotensin I to active angiotensin II which is a potent vasoconstrictor
What are examples of ACEI ?
Ramipril
Perindopril
What are the contraindications of ACEI ?
Renal artery stenosis: - may precipitate renal failure of renal infacrtion Impaired renal function: - renal failure Hyperkalaemia: - worsens it Fertile female: - teratogenic
