4 - Hypertension and Heart Failure Drugs Flashcards
What are the effects of hypertension and how is bp regulated?
- Increases arterial wall thickness by remodelling and hypertrophy. Stiffens the walls so they are less compliant
- Organ damage from lack of blood flow
- Regulated by RAAS, autonomic NS, bradykinin, NO and natriuretic peptides
What are the values that define hypertension and what are some of the causes?
>140/90
primary, secondary (conn’s, diabetes), isolated diastolic/systolic, white coat
What are target blood pressures (clinically and ambulatory) for different groups of people?
- <140/90 if less than 80 inc type II diabetes
- <150/90 if greater than 80
- <135/85 if type I diabetic
What is best practice when diagnosing hypertension?
- Sitting relaxed and arm supported
- Both arms should be within 15mm/Hg of each other, if not then repeat. Take highest reading
- Measure over a period of time including ambulatory and hoe machines
- CVD and organ damage should be assessed whilst waiting for hypertension confirmation
What are the stages of hypertension?
- Resistant hypertension at stage 3
- Emergency if >180/120 and clinical signs
What is prehypertension and how can progression of this be limited
>120/80 but less then 140/90
- Promote regular exercise
- Healthy balanced diet
- Reduce stress and increase relaxation
- Limit alcohol and caffiene intake
- Smoking cessation
- Reduce salt in diet
In general what are some classes of drugs that are used to treat primary hypertension?
- ACE inhibitors
- ARBs
- Calcium channel blockers
- Diuretics
- Alpha and Beta blockers
What is the mechanism of action of ACEi’s to treat hypertension?
Competitive inhibitors of Angiotensin Converting Enzyme:
- Reduce formation of angiotensin II
- Arteriole vasodilation
- Reduce circulating aldosterone so less ADH
- Build up of bradykinin which is a vasodilator as makes NO, good for low renin hypertensives
What are some examples of ACEi’s?
- Ramipril
- Lisinopril
What are some side effects of ACEi’s?
Side effects:
- Dry cough*
- Hypotension
- Hyperkalaemia* as loss of aldosterone
Aldosterone causes reabsorption of sodium and, subsequently, water. Consequently, protons and potassium get secreted into the urine.
- Renal failure especially due to renal artery stenosis as efferent arteriole needs to constrict
- Angiooedema* due to BK, especially black population
What are some contraindications of using ACEi’s?
- Pregnancy (along with ARBs, can cause CVS and CNS defects and growth restriction and oligohydraminos)
- Hyperkalaemia
- NSAIDs, K+ raising drugs, antihypertensives
PARK NA
- AKD
- Breastfeeding
- Renal artery stenosis
What is the mechanism of action of ARBs?
- AngII mainly binds to AT1 receptor
- Inhibits vasoconstriction better than ACEis as the AT1 receptor blocked so any AngII made from chymases can not work either
- Inhibits aldosterone stimulation
- Less effective in low renin hypertensives as no effect on bradykinin
What are some examples of ARBs?
- Candesartan
- Losartan
What are some side effects and contraindications of ARBs as antihypertensives?
Side effects:
- No dry cough and angiooedema like ACEi
- Renal failure
- Hyperkalaemia
Contraindications:
- AKD
- Pregnancy and breast feeding
- Renal artery stenosis
- K+ raising drugs, NSAIDs, other antihypertensives
What is the mechanism of action of calcium channel blockers?
- Bind to alpha1 subunit of L-type calcium channel (VOCC), reducing cellular calcium entry causing vasodilation, reducing preload on the heart
- LTCC in vascuar smooth muscle, cardiomyocytes, SA and AV node. Different classes selective for different areas
If a patient had hypertension with low renin levels, what class of drug would be best to prescribe them first?
- CCB as doesn’t target RAAS
- ACEi as increases bradykinin
For example, medications that target the RAAS system, such as ACE inhibitors or angiotensin receptor blockers (ARBs), may not be as effective in patients with low-renin hypertension because the RAAS system is already less active in these patients. In contrast, medications that work through other mechanisms, such as CCBs or diuretics, may be more effective in reducing blood pressure in these patients.