10/14 Flashcards
HTN diagnosis
-Often asymptomatic (may observe dizziness or headache)
-Two or more measurements of blood pressure with
diastolic pressure > 90 mm Hg, Systolic pressure > 140 mm Hg
-Pulse Pressure (SBP-DBP) > 65 mm Hg VERY important
indicator
- >50 yo, SBP > 140 mm Hg very important cardiovascular
disease risk factor
pre HTN
120-139 / 80-89
stage 1 HTN
140-159 / 90-99
stage 2 HTN
> 160 / > 100
BP = __ x __
CO x PVR
chronic BP is controlled by
kidneys
angiotensin pathway
angiotensinogen -(renin)-> ang I -(ACE)-> ang II
normal BP
less than 120/80
essential or primary HTN
- 85- 90% of cases
- no identifiable cause
- increase peripheral vascular resistance (PVR); normal cardiac output (CO)
essential HTN risk factors
FH, sex, diet, smoking, DM, hyperlipidemia
other causes of HTN
- renal artery constriction
- coarctation of the aorta
- pheochromocytoma
- cushing’s
- primary aldosteronism
why treat HTN?
end organ damage: kidney, heart, brain
goal of HTN therapy
-reduce diastolic BP to reduce incidence of end organ damage
BP = CO x PVR
-reduce CO
-reduce PVR (vasodilation, decrease blood volume)
actions of ang II
- vasoconstrictor
- stimulates aldosterone release (aldosterone stimulates Na/water retention)
reserpine MOA
inhibits dopamine pump into vesicles, dopamine cant be converted to NE, NE cant be released into the synapse; depletes vascular pool of NE; slow onset of action, sustained effect
reserpine SE
GI (diarrhea, cramps, acid secretion), CNS (sedation, nightmares, depression)
a2 receptor agonists MOA
K+ flows out of cell, hyperpolarization, less chance of response, decrease sympathetic output
clonidine class
a2 receptor agonists
why is clonidine lipophilicty important?
must cross BBB to reach medulla
clonidine SE
dry mouth, sedation, depression, withdrawl syndrome, Na and water detention
a1 receptor antagonists
vasodilaion, “quinazolines”, prazosin, terazosin, doxazosin
a1 receptor antagonists SE
“first dose” effect (orthostatic hypotension), Na and water retention, slight tachycardia
beta blockers overview
dec CO and HR, reduce renin release (beta1 receptors in kidney), recheck lipids after 3-4 months (transient changes), hypoglycemia, bronchial resistance
cardio selective B blockers
metoprolol, atenolol,
3rd generation B blockers
Nebivolol - B blocking action and vasodilation due to nitric oxide production
B blockers SE
bradycardia, AV block, sedation, mask hypoglycemia, withdrawl symptoms (upregulation of receptors), minimal compensatory responses
B blockers CI
asthma, COPD, CHF (IV)
mixed adrenergic receptor antagonists
labetalol, carvidilol
B and a1 receptors antagonist, racemic mixture, vasodilator (a1), dec renin release (B)
