Kirsty FTY > Hypertension > Flashcards

Hypertension Flashcards

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1
Q

What is stage 1 HT defined as?

A

Clinical blood pressure is 140/90 or higher and subsequent ABPM or HBPM average is 135/85mmHg or higher.

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2
Q

What is stage 2 HT defined as?

A

Clinical blood pressure is 160/100 mmHg or higher and subsequent ABPM or HBPM average is 150/95 mmHg or higher

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3
Q

What is stage 3 HT defined as?

A

Clinical systolic is 180 mmHg or higher OR clinical diastolic is 110 mmHg or higher

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4
Q

What blood pressure monitor should be used for patients with irregular heart rhythm?

A

Mannual BPM

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5
Q

Described the process of recording BP using an automated device.

A

The patient should be seated in a chair with a back rest and have their feet on the floor for at least 5 minutes while relaxed and not speaking.

Check the pulse. If any irregularity is found, use a manual device.

The arm should be supported at the level of the heart, resting on a cushion, pillow or arm rest. Place the cuff on 2cm above the brachial artery and align the “artery mark”. Use the correct cuff size as recommended by the manufacturer.
Repeat 3 times and record measurements.

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6
Q

Describe the process of checking BP using a mannual device

A

In addition to the steps above, follow the steps below.
Estimate the systolic beforehand:
* Palpitate the brachial artery
* Inflate cuff until pulsation disappears
* Deflate cuff
* Estimate systolic pressure

Then inflate to 30 mmHg above the estimated systolic level to occlude the pulse.

Place the stethoscope over brachial artery and deflate at rate of 2-3 mm/sec until you hear regular tapping sounds. Measure systolic (first sound) and diastolic(disappearance) to the nearest 2 mmHg.

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7
Q

What are examples of essential investigations to be carried out for HT

A
  • Urinalysis – test for protein in urine
  • Renal function – test for CKD
  • Glucose – test for diabetes
  • Lipid Profile – estimation of CV risk using e.g. Qrisk
  • ECG – test for LV hypertrophy and/or heart conditions
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8
Q

What are examples of modifiable and non-modifiable risk factors for HT?

A

Modifiable:
* Alcohol consumption
* Smoking
* High salt diet
* Obesity
* Lack of physical exercise
* Diabetes

Non-modifiable:
* Age
* Race
* Family History

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9
Q

When recording BP if there is a difference of ________mmHg between both arms:

  1. What should you do?
  2. What happens if the same output occurs?
A
  • If the reading between arms is 15 mmHg or greater then repeat measurements.
  • If the readings between arms remains 15 mmHg or greater then measure subsequent blood pressure readings on the arm with the higher reading.
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10
Q

What lifestyle advice should be given to patients with HT to reduce CVD risk?

A
  • Reduce salt intake to 5-6g per day
  • Moderate alcohol consumption
  • Increased consumption of veg, fruit and low-fat dairy products
  • Reduction of weight to BMI of 25kg/m2 and of waist circumference to <102cm in men and <88cm in women
  • Regular exercise (i.e. at least 30 minutes moderate intensity exercise 5-7 days a week)
  • Quit smoking
  • Relaxation therapies
  • Discourage excessive consumption of coffee and other caffeine rich products
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11
Q

What are examples of ARBs and their doses?

A
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12
Q

What are some examples of ACEi and their doses?

A
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13
Q

What are CI to ACEi and ARB?

A
  • Angioneurotic oedema (not for ARB)
  • Pregnancy / breastfeeding
  • Diabetes Mellitus (or eGFR <60mL/min) taking Aliskiren

Valsartan:
* Cholestasis

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14
Q

What are side-effects of ARBs and ACEi?

A
  • Renal impairment
  • Hyperkalamiea
  • Angio-oedema
  • Dizziness
  • Abdominal pain, cough, diarrhoea, headache, vertigo, vomiting, postural hypotension
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15
Q

What level of K+ would you stop ACEi/ARB?
What if the values were lower than this?

A
  • K+ >5mmol/L  investigate and stop/reduce dose of K+ sparing drugs or nephrotoxic drugs
  • K+ 5 – 5.9mmol/L  Reduce dose and check K+ in 5-7 days
  • K+ >6mmol/L  Stop
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16
Q

What interactions can occur with ACEi and ARBs?

A
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17
Q

What monitoring should occur with ACEi and ARBs?

A

Baseline:
* * Renal function and U&Es

There after:
* * Renal function and U&Es 1-2 weeks after starting treatment and after each dose increase. Thereafter, renal function and U&Es annually
* * BP 4 weeks after dose titration

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18
Q

What dose of indapamide is used?

A

2.5mg OM

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19
Q

Should CCB (dihydropyridines) be used in pregnancy?

A

Best avoided unless no alternative

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20
Q

CI to indapamide

A
  • Addison’s disease
  • Hypercalcaemia
  • Hyponatraemia
  • Refractory hypokalaemia
  • Symptomatic hyperuricemia
  • Severe renal impairment (CrCl <30 – lack of efficacy)
  • Severe liver impairment
  • Pregnancy / breastfeeding
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21
Q

Cautions to indapamide

A
  • Gout (Exacerbate)
  • Diabetes (Exacerbate)
  • Systemic lupus (Exacerbate)
  • Risk of hypokalaemia
  • Acute prophyrias
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22
Q

Monitoring of indapamide?

A

Baseline
* Renal function
* U&Es
* LFTs

Thereafter
* Renal function and U&ES regularly thereafter
* LFTs if suspected liver impairment
* BP 4 weeks after titration then annually
* Monitoring of glucose in diabetes

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23
Q

Are B-blockers reccomended in HT treatment?

A

Beta-blockers are not recommended for the initial treatment of hypertension. Recent data shows that beta blocker treatment is inferior to other treatments in terms of cardiovascular protection. This, plus the increased risk of new onset diabetes, means that beta blockers are no longer first line treatment for hypertension. They are sometimes used in the treatment of ‘resistant hypertension’ (stage 4) in combination with a CCB, ACE/ARB & thiazide.

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24
Q

What are cautions to ACEi and ARBs

A
  • Diabetes (may lower blood glucose)
  • First dose hypotension
  • Black African or African-Caribbean origin
  • Aortic or mitral valve stenosis
  • Renal impairment – hyperkalaemia & ADR more common
  • Hepatic impairment
  • Elderly
  • Diuretics
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25
Examples and doses of dihydropyridines
26
MOA of all CCB
Calcium-channel blockers (less correctly called ‘calcium-antagonists’) interfere with the inward displacement of calcium ions through the slow channels of active cell membranes. They influence the myocardial cells, the cells within the specialised conducting system of the heart, and the cells of vascular smooth muscle. Thus, myocardial contractility may be reduced, the formation and propagation of electrical impulses within the heart may be depressed, and coronary or systemic vascular tone may be diminished.
27
What is a common side effect of CCB (dihydropyridines)
Ankle swelling
28
Can diuretics be used to treat ankle odema caused by diuretics?
Diuretics have little effect on CCB-induced ankle oedema. This is because the oedema is caused by vasodilatory induced fluid pooling, rather than water retention.
29
CI of D CCB
* Unstable / acute HF * Unstable angina
30
CI of D CCB
* Unstable / acute HF * Unstable angina
31
Side-effects
* Postural hypotension * Hyperglycaemia * Hypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia * Dizziness and headache
32
MOA CCB
CCB’s reduce calcium influx into vascular smooth muscle cells. This promotes vasodilation, and reduces blood pressure
33
Is CCB ankle swelling related to dose?
Yes - dose related. Increasing dose is likely to worsen swelling
34
Side-effects of D CCB
* Ankle swelling * Angio-oedema * Dizziness / flushing * Headache * Skin reactions * nausea * Palpitations/tachycardia
35
Monitoring for CCB
No specific monitoring
36
Cautions of D CCB?
* Tachyarrythmia * Chronic HF * Pregnancy/breastfeeding (best avoided unless no alternative)
37
Can CCB precipitate HF
yes in those predisposed
38
Interactions with indapamide?
39
What are examples of R CCB
verapamil diltiazem
40
What are CI to R CCB
* AV Block (grade 2 or 3) * Severe bradycardia or sick sinus syndrome * HF or moderate-severe LV dysfunction * Pregnancy/breastfeeding
41
What is the only CCB that can be used in HF
amlodipine
42
What are side-effects of R CCB
* Peripheral oedema * Angio-oedema * Dizziness / flushing * Headache * Skin reactions * nausea * Palpitations/tachycardia
43
Monitoring of R CCB
pulse monitoring
44
Interactions with CCB (R and D)
45
Which statin and which CCBs require reduced dosing
Max 20mg SIMVASTATIN with * amlodipine * Diltiazem * Verapamil
46
What are cautions to R CCB
* AV block (grade 1) * Hepatic impairment
47
CI to B-blocker
* Asthma (pick cardioselective if required) * AV Block (Grade 2/3) * Severe bradycardia or sick sinus syndrome * Severe Peripheral arterial disease
48
Cautions B-blockers
* 1st degree AV block * Glucose intolerance / Diabetes (can mask hypoglycaemia signs) * COPD * Metabolic syndrome * Psoriasis * Mysathaenia gravis * Pregnancy/breast feeding
49
Examples and doses of B-blockers
* Atenolol (usual dose 25-50mg. Max dose 100mg) * Bisoprolol (Initial 5mg. Usual 10mg. Max 20mg) * Carvediol * Metoprolol * Labetolol * Propranolol (initial 80mg BD. Usual dose 160-320mg BD)
50
Side-effects of BB
* Bradycardia * Bronchospasms * Cold extremities * GI discomfort * Hyperglycaemia/hypoglycaemia * Hypotension * Sleep disturbances (atenolol, celiprolol and nadolol are water soluble so less likely to cross BBB)
51
Interactions for B-blockers
52
Monitoring for B-blockers
* Monitor pulse * Monitor glucose in diabetics
53
Which BB is licenced in pregnancy
* Labetalol is licensed in HT in pregnancy
54
Which BB is licenced in pregnancy
* Labetalol is licensed in HT in pregnancy
55
Which BB have cardioselectivity
* Atenolol, bisoprolol, metoprolol, nebivolol are relatively cardioselective
56
Dose of spirolactone
25mg OM with food
57
CI spirolactone
* Acute or severe renal failure (eGFR <30mL/min) * Hyperkalaemia * Pregnancy/breastfeeding
58
Cautions spirolactone
* Hepatic insufficiency
59
Side-effects Spirolactone
* AKI * Dizziness * Changes in libido * Hepatoxicity * GI disturbnces * Hyperkalaemia, hyponatraemia * Rash * Hyperuricaemia
60
Interactions spirolactone
61
Monitoring spirolactone
Baseline * Renal function * U&Es Thereafter * Renal function and U&Es after 1 month. Thereafter accordingly to clinical judgement
62
What K+ level must pt have to be started on spirolactone?
* Spirolcatone – mut have K+ of 4.5mmol/L or less to use
63
At what level should spirolactone be stopped in relation to K+
* If K+ greater than 5mmol/L – stop and treat K+
Kirsty FTY
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