Managing Elevated Blood Pressure

Describe Angiotensin converting enzyme inhibitors

Action: vasodilation by preventing conversion of Ang1 to Ang2

Effect: Reduces BP by 6-7 / 3-5 mmHg

Side effects: Persistent dry cough, hyperkalaemia (High potassium), worsening renal failure, angiodema (swelling of the deeper layers of the skin, caused by a build-up of fluid), hypotension, electrolyte imbalance

Give ACEi medication examples

Ramipril
Enalapril
Lisinopril

Describe Angiotensin receptor blockers

Action: directly block AT2 receptor on blood vessels causing vasodilation

Effect: Reduces BP by 6-7 / 3-5 mmHg

Side effects: Hyperkalaemia, worsening renal failure, angiodema, hypotension, electrolyte imbalance

Give ARB medication examples

Losartan
Candesartan

What risk factors are there for cardiovascular disease?

High risk diseases:
Hypertension, Diabetes, Hyperlipidaemia, Obesity

Non-modifiable risk factors:
Age, Gender, Family history, Ethnicity

Unhealthy lifestyle:
Cigarette smoking, Physical inactivity, Diet high in fat, Psychosocial stress

Alcohol intake - drinks approximately 23 units per week - up to 14 units is the recommended weekly allowance.
High sodium diet - patient uses salt in cooking and adds to her food.
High caffeine intake

What lifestyle measures would you recommend for cardiovascular disease?

• Smoking cessation, with the option of NRT and/or cognitive therapy to assist this.
• Reduce alcohol intake to less than 14units per week, preferably split over the week.
• 150 minutes moderate or 75 minutes vigorous physical activity a week
• Reducing salt intake (less than 6g salt daily - practical advice about reducing intake and substituting with Low sodium options.
• Eating a varied diet rich in fruit and vegetables + reducing caffeine intake.

Describe Diuretics

Action: Stop the resorption of sodium hence leading to more urine being produced.

Effect: Reduces BP by 8-10 / 3-5 mmHg

Side effects: Constipation, electrolyte imbalance, headache, postural hypotension, hyperuricaemia (elevated serum uric acid level)

Give Diuretics medication examples

thiazides

e.g. bendroflumethiazide, indapamide

How should ACEi be monitored?

Renal function and electrolytes should be checked before starting ACE inhibitors (or increasing the dose) and monitored during treatment (more frequently if side effects mentioned are present). (BNF)

Blood pressure

How should ARB be monitored?

Monitor plasma-potassium concentration, particularly in the elderly and in patients with renal impairment. (BNF)

In reality, would also monitor creatinine clearance

Blood pressure