L27 Therapeutics of Hypertension

Hypertension is very common, with a prevalence [blank_start]22[blank_end]% in adults. It is more common with age, Maori and PI ethnicity, in younger men, older women, in the obese, those with a [blank_start]sedentary[blank_end] lifestyle, high fat/salt/sugar diet, and caffeine/nicotine/alcohol intake. There is a [blank_start]10[blank_end]% mortality in patients with uncontrolled hypertension.

Stage one (mild) hypertension: a clinic BP measurement of ≥[blank_start]140/90[blank_end] mmHg, or an average daytime ambulatory BP of ≥[blank_start]135/85[blank_end] mmHg. Stage two (moderate) hypertension: a clinic BP of ≥[blank_start]160/100[blank_end] mmHg, or an average daytime ambulatory BP of ≥[blank_start]150/95[blank_end] mmHg. Severe hypertension: a systolic pressure of ≥[blank_start]180[blank_end] mmHg, or a diastolic pressure of ≥[blank_start]110[blank_end] mmHg.

Principles of HTN treatment include lifestyle changes, [blank_start]drugs[blank_end] to cause vasodilation, to assess ([blank_start]calculate[blank_end]) 5-year cardiovascular risk, and to modify/reduce CV risks. Goals of treatment: - Prevent, or [blank_start]slow[blank_end] the progress, of organ [blank_start]damage[blank_end] and complications - Provide [blank_start]optimal[blank_end] treatment in terms of dose, dosing schedule, combination therapy, and adverse effects - Optimise [blank_start]adherence[blank_end] Target BP is < [blank_start]140/90[blank_end] mmHg for most people, < [blank_start]130/80[blank_end] mmHg for patients with chronic kidney disease (CKD), diabetes, or established cardiovascular disease.

Which of these is not a non-pharmacological treatment for HTN?

Treatment steps: - Start with [blank_start]ACEI[blank_end]. Use [blank_start]ARB, or CCB[blank_end] if contraindicated or if ACEI causes cough. - Add a [blank_start]CCB[blank_end] to ACEI or ARB. - Add a [blank_start]thiazide diuretic[blank_end] In diabetics: ACEI is first line as it’s [blank_start]reno-protective[blank_end]. In IHD or AF patients: include a beta-blocker early as it's [blank_start]cardio-protective[blank_end] In HF patients: include a [blank_start]low[blank_end] dose beta-blocker Check [blank_start]adherence[blank_end] and [blank_start]adverse[blank_end] effects at each step.