Hypertension

• Hypertension stages


  • Stage 1: 140/90-159/99 (clinic) OR 135/85-149/94 (ambulatory)
  • Stage 2: 160/100-180/120 (clinic) OR >150/95
  • Stage 3: >180/120 medical emergency
• Hypertension treatment


  Stage 1: Drug + lifestyle advice

  Stage 2: ACE/ARB, ACE/ARB+CCB/TLD

  Stage 3: Immediate drug treatment
• ACE inhibitors


  Ramipril, enalapril, lisinopril, perindopril

  Cough, hyperkalaemia, hepatic failure, angioedema, renal impairment, dizziness + headaches
• ARBs


  Candesartan, irbesartan, losartan, valsartan

  Same effects as ACE inhibitors except cough + angioedema
• 1. blockers, ARBs, k-sparing diuretics

  Cause hyperkalaemia
• Diuretics, NSAIDs, B-blockers, ARBs, k-sparing diuretics

  Cause volume depletion
• 1. blockers


  • atenolol, bisoprolol, carvediol, bibetolol, propranolol, sotalol, timolol
• b-blockers, digoxin

  Cause heart block
• Calcium channel blockers (CCBs)


  Dihydropyridines (amlodipine, felodipine, lacidipine, barnidipine, nifedipine) - vasodilatory effects, rate-limiting (diltiazem, verapamil) - complete AV block, gingival hyperplasia
• Dihydropyridine CCBs


  • Cause flushing, headaches, ankle swelling
• Dihydropyridine CCBs


  Contraindicated in diabetes, kidney disease, hypertension, autoimmune disease
• Aspirin


  Should be taken from week 12 until birth in pregnancy
• Blood pressure >140/90 mmHg in pregnancy


  Treat with labetalol, nifedipine/methyldopa
• Cardioselective B-blockers


  • Bisoprolol
  • Atenolol
  • Metoprolol
  • Acebutolol
  • Nebivolol
• Cardioselective B-blockers


  Bronchospasm risk
• Water soluble, intrinsic sympathomimetic, BBB crossing + cold extremities, nightmares


  • Celiprolol
  • Pindolol
  • Acebutolol
  • Atenolol
  • Nadolol
  • Sotalol
• Once daily beta-blockers


  • Bisoprolol
  • Atenolol
  • Nadolol
  • Celiprolol
• Arteriolar vasodilating effect


  • Celiprolol
  • Nebivolol
  • Carvedilol
  • Labetalol
• Hypertension targets


  • <80yrs 140/90 (clinic), 135/85 (ambulatory)
  • >80yrs 150/90 (clinic), 145/85 (ambulatory)
  • Renal disease 140/90 (clinic)
  • Pregnancy 135/85 (clinic)
  • T1DM 135/85 (clinic)