01a: HTN Flashcards
Normal BP according to JNC 7 classification
Systole: under 120
Diastole: under 80
Pre-hypertension BP according to JNC 7 classification
S: 120-139
D: 80-89
Hypertension stage I BP according to JNC 7 classification
S: 140-159
D: 90-99
Hypertension stage II BP according to JNC 7 classification
S: over 160
D: over 100
List the antihypertensive drug classes
- Diuretics
- Sympatholytics (affect adrenergic function)
- Vasodilators
- RAAS affecting agents
(Thiazide/loop) diuretics are used for HTN. Give the name of the prototype. What’s the mechanism?
Both but mainly thiazide (loop diuretics rarely used);
Hydrochlorothiazide
Enhance Na, K, H2O excretion by preventing reuptake of Na in kidney
Lisinopril is in (X) class of drugs, used to treat (Y).
X = ACE inhibitor
Y = HTN
Losartan is in (X) class of drugs, used to treat (Y).
X = ARB (Angiotensin Receptor Blockers)
Y = HTN
Ca channel blockers are used as anti-HTN agents for their (X) effect.
X = vasodilator
First-line treatment for uncomplicated HTN.
Thiazide diuretics (hydrocholorothiazide)
(X) class of drugs is used to treat HTN. It’s very powerful, especially for removal of edema (ex: pulmonary).
X = loop diuretics
Initial versus chronic use of diuretics will lower BP by which mechanisms?
Initial: lower CO and plasma volume
Chronic: vasodilation (by decreasing Na/Ca exchange and thus lowering intercellular Ca levels)
T/F: diuretics will allow reduction in RAAS activity.
False - stimulates it due to low volume/Na
(X) is beta-blocker used to treat HTN. Which receptor(s) does it target?
X = metroprolol
Beta-1 (cardiac, renal)
What are the mechanisms by which beta-blocker, (X), reduces BP?
X = metroprolol
Cardiac: decrease HR, contractility, CO
Renal: decreases RAAS (thus, decrease TPR/afterload)
CNS alpha-2 (agonists/antagonists) are used to treat HTN.
Agonists (but not first-line and can be troublesome in elderly patients)
Alpha-1 (agonists/antagonists) used as anti-HTN therapy. What’s the prototype?
Alpha-1 antagonists;
Prazosin
T/F: Prazosin is one of the first-line anti-HTN agents.
False, not first-line
Adverse effect of Prazosin as HTN treatment is (X). Thus, should be avoided in (Y) patients.
X = tachycardia Y = CHF
Ca channel blockers can be non-selective or selective for:
Arterial smooth muscle (Vaso-selective) or cardiac tissue (cardio-selective)
List the Ca channel blockers used to treat HTN. Which ones are selective?
- Diltiazem
- Nifedipine (Vaso-selective)
- Verapamil (cardio-selective)
Ca channel blockers are preventing Ca (entry/exit) (into/from) (X) cells.
Entry into;
Vascular smooth muscle (Nifidipine) or cardiac myocytes (verapamil)
First recommended treatment option for HTN is (X). If the BP goal of (Y) is not achieved, what is the next step?
X = lifestyle modification Y = under 140/90 (unless diabetic or CKD: under 130/80)
Consider initial drug choices
HTN: Threshold to start pharmacological therapy in patients age 60 and above.
SBP over 150
Or
DBP over 90
HTN: Threshold to start pharmacological therapy in patients under 60.
SBP over 140 or
DBP over 90
HTN: Threshold to start pharmacological therapy in patients with DM or CKD.
SBP over 140 or
DBP over 90
Patient with BP of 130/95 falls into which category of HTN?
Hypertension stage I (since diastolic BP over 90)
T/F: Systolic (not diastolic) BP more often predicts CV complications.
True