Treatment of hypertension Flashcards
(50 cards)
How do you assess the risk of hypertension
Previous MI, stroke, IHD Smoking Diabetes mellitus Hypercholesterolaemia Family history ( heart disease) Physical Examination
What must you asses on clinical finding of hypertension
Assses for end organ damage,
What are the different techniques used to assess for end organ damage in hypertension
Heart -
ECG + Echocardiogram
Renal -
Renal ultrasound
Assses renal function - GFR
On the assessment of hypertension, what types of treatable cases do you screen for
Renal artery stenosis/FMD
Cushings disease
Conn’s Syndrome
Sleep apnoea
At what percentage risk factor for CVD should treatment be started
20% risk
why should people with low risk at a young age but high BP be treated
As damage will increase with time, as the overall risk is only low now due to your age
Why should women with low risk but high blood pressure be treated
As women going on to become pregnant at a much higher risk of pre-eclampia which threatens both mothers and childs life
What method is used in the treatment plan of hypertension
A stepped approach using the low does of several drugs
using lowest dose and working way up, try and minimise constant change of drug
When would you offer stage one hypertensive treatment
people aged under 80 years with ABPM >140/90
with one or more of the following:
target organ damage
established cardiovascular disease
renal disease
diabetes
a 10-year cardiovascular risk equivalent to 20% or greater.
When would you offer stage 2 treatment of hypertension
ABPM> 160/100
risk and age doesn’t matter now
What strength of treatment does those over 80 years receive, and what is take into consideration
same antihypertensive drug treatment as people aged 55–80 years
co morbidities
What is the blood pressure target for those over 80 years, and why is it this
<140/90
Blood pressure is a higher target, so have a little more risk but therefore have a lower risk of falling over - improve quality of life
In step 1 hypertensive treatment when do you offer a calcium channel blocker
to people aged over 55 years and to black people of African or Caribbean family origin of any age
When would a calcium channel blocker be unsuitable in stage 1 hypersensitivity what would be offered an alternative
intolerance or if there is evidence of heart failure - oedema
or
high risk of heart failure
thiazide like diuretic
When would you offer ACEI/ARB in step 1 hypertension treatment
Patient under 55
Who is not suitable for ACEI/ ARB in step 1 hypertension treatment
Afro Caribbean
Women of child bearing
patients over 55
What is step 2 hypertension treatment
Add Thiazide-type diuretic such as clortalidone or indapamide to
CCB or ACEI/ARB
What is stage 3 hypertension treatment
Add CCB, ACEI, Diuretic together
When would you consider step 4 hypertension treatment and what do you need to take into account
For treatment of resistant hypertension
blood potassium level
What is stage 4 treatment if the blood potassium level is 4.5 mmol/l or lower
Consider further diuretic therapy with low-dose spironolactone (25 mg once daily)
What is stage 4 treatment if the blood potassium level is higher than 4.5 mmol/l
Consider higher-dose thiazide-like diuretic treatment
What patients do you have to be cautious of in stage 4 treatment
patients with a reduced estimated GFR because they have an increased risk of hyperkalaemia.
Examples of Angiotensin Converting Enzyme
Inhibitors
Ramipril, Perindopril
How does ACEI work
Competitively inhibit the actions of angiotensin converting enzyme (ACE) prevents the activation of angiotensin II
preventing vasocontriction and and prevents hypertrophogenic
