Anti Hypertensive Drugs

Question 1

What is hypertension

Answer 1

Blood pressure is the force of circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when the force of the blood pressure is excessive.
Most people with high blood pressure
DO NOT KNOW THEY HAVE IT.

Question 2

Hypertension is diagnosed if blood pressure readings are
—— or above on —- different days.

Answer 2

Hypertension is diagnosed if blood pressure readings are
140-90 or above on two different days.

Question 3

Hypertension is not the Most common cardiovascular dx. Tor F

Answer 3

F

Most common cardiovascular dx.

Question 4

Hypertension is Asymptomatic in most cases. Tor F

Answer 4

T

Question 5

If hypertension is untreated , usually lead to complications such as ———, ———, ———, ——— and ———.

Answer 5

Untreated, usually lead to complications such as stroke, heart failure, kidney failure, ischaemic heart dx and death.

Question 6

How many people worldwide have hypertension

Answer 6

1.13 billion people worldwide have hypertension

Question 7

Hypertension is a silent killer. Tor F

Answer 7

T

Question 8

Epidemiology of hypertension
▪Prevalence is decreasing world wide. T or F

▪—% of adult population in the U.S. ▪More prevalent in Nigeria — - —%. ▪Affect some races and gender.T or F
▪Mainly 2 types; which are:

Answer 8

Epidemiology
▪Prevalence is increasing world wide. ▪18% of adult population in the U.S. ▪More prevalent in Nigeria 25- 30%. ▪Affect all races and gender.
▪Mainly 2 types
▪1. Primary (Essential) HTN
▪2. Secondary HTN – “RENVAP”.

Question 9

▪1. Primary (Essential) HTN – —%,
Not idiopathic and also not associated with risk factors Tor F
▪2. Secondary HTN – list the medical conditions it’s associated with

Answer 9

1. Primary (Essential) HTN – 90%,
   idiopathic, but associated risk factors ▪2. Secondary HTN – “RENVAP”.
   R- renal
   E-endocrine(thyrotoxicosis,pheochromocytoma)
   N-neuronal( cerebral neuropathy, NF)
   V-Vascuar
   A-vascular
   P- pregnancy

OR

RENALS
© Renal -+ glomerulonephritis, renal artery stenosis)
© Endocrine -+ Cushing’s disease, Conn’s syndrome, pheochromocytoma, acromegaly. corticosteroids, oral contraceptive pill)
Neurogenic- raised intracranial pressure
© Aortic coarctation
© Little people - pregnancy-induced hypertension)
© Stress - trauma, white coat hypertension

Question 10

Classification

ESH-ESC1
BP category Systolic. Diastolic
(mmHg). (mmHg)
-Optimal. ———. & ———
-Normal. ———. &/or ———
-High normal. ———. &/or ———
-Grade 1(mild) ———. &/or ———
-Grade 2. ———. &/or ———
(Moderate)
-Grade 3. ———. &/or ———
(Severe)
-Isolated ———. & ———
Systolic
HTN

Answer 10

ESH-ESC1
BP category Systolic. Diastolic
(mmHg). (mmHg)
-Optimal. <120. & <80
-Normal. 120-129. &/or 80-84
-High normal. 130-139. &/or 85-89
-Grade 1(mild) 140-159 &/or 90-99
-Grade 2. 160-179. &/or 100-109
(Moderate)
-Grade 3. >/=180. &/or >/=110
(Severe).
-Isolated >/=140. & <90
Systolic
HTN

Question 11

Classification of hypertension

INC 72

BP category Systolic. Diastolic
(mmHg). (mmHg)

-Normal. ———. &/or ———
-pre-HTN. ———. or ———
-Stage 1. ——— or ———
-stage 2. ——— or. ———

Answer 11

BP category Systolic. Diastolic
(mmHg). (mmHg)

-Normal. <120 &/or <80
-pre-HTN. 120-139 or 80-89
-Stage 1. 140-159 or 90-99
-stage 2. >/=160 or. >/=100

Question 12

Classification of HTN severity

BP category Systolic. Diastolic. Risk
(mmHg). (mmHg)
-Normal. ———. ———. ——
-pre-HTN. ———. ———. ——
-Stage 1(mild) . ———. ———. ——
-Stage 2 ———. ———. ——
(Moderate)
-Stage 3. ———. ———. ——
(Severe)
-stage 4. ———. ———. ——
(Very Severe)

Answer 12

Classification of HTN severity

BP category Systolic. Diastolic. Risk
(mmHg). (mmHg)
-Normal. <130 <85 None
-pre-HTN. 120-139 80-90. Slight
-Stage 1(mild) .140-159 90-99. Longterm
-Stage 2 160-179 100-109. 50% in
(Moderate). 5yrs
-Stage 3. 180-209. 110-119. 40% in
(Severe). 2yrs
-stage 4. >210. >120. Emer
(Very Severe) gency

Question 13

Physiology of Blood pressure
▪BP = ———- X ——-.
▪Arterial pressure affected by:
▪– ————-
▪– ————-
▪– ————-

Answer 13

Physiology of Blood pressure
▪BP = Cardiac Output X Peripheral Vascular Resistance.
▪Arterial pressure affected by:
▪– the autonomic nervous system (fast)
▪– the renin-angiotensin system (hours or days) ▪– the kidneys (days or weeks)

Question 14

Hypertension- Pathophysiology
▪Effective pharmacologic lowering of blood pressure prevents the damage to ———- and reduces the ——- and ——— rate.
▪In order to understand the pathophysiology of hypertensive states and, in turn, the underlying rationale of drug therapy, an appreciation of the systems normally involved in monitoring and regulating ———- is required.
▪Two factors which determine blood pressure are ———- and ———-of the vasculature.

Answer 14

Hypertension- Pathophysiology
▪Effective pharmacologic lowering of blood pressure prevents the damage to blood vessels and reduces the morbidity and mortality rate.
▪In order to understand the pathophysiology of hypertensive states and, in turn, the underlying rationale of drug therapy, an appreciation of the systems normally involved in monitoring and regulating blood pressure is required.
▪Two factors which determine blood pressure are cardiac out put (stroke volume x heart rate) and total peripheral resistance of the vasculature.

Question 15

Antihypertensive therapies include:

Answer 15

Antihypertensive therapies
1.Non pharmacological therapy of hypertension

2. Pharmacological therapy of hypertension.

Question 16

Antihypertensive therapies
1.Non pharmacological therapy of hypertension include:

Answer 16

Antihypertensive therapies
1.Non pharmacological therapy of hypertension
◦ Low sodium chloride diet
◦ Weight reduction
◦ Exercise
◦ Cessation of smoking
◦ Decrease in excessive consumption of alcohol
◦ Psychological methods (relaxation, meditation …etc)
◦ Dietary decrease in saturated fats.

Question 17

Classification of anti-hypertensive by
site or mechanism:

Answer 17

Classification of anti-hypertensive by
site or mechanism
A. Sympatholytic drug
B. Calcium channel blockers (CCB)
C. Angiotensin-converting enzyme Inhibitors(ACEI) D. Angiotensin II receptor antagonists (ARB)
E. Vasodilators
F. Diuretics

Question 18

Classification of anti-hypertensive by site or mechanism

A.Class:Sympatholytic drug
Mechanism of action:——

B. Class:Calcium channel blockers (CCB)
Mechanism of action: ———

C. Class: Angiotensin-converting enzyme Inhibitors(ACEI)
Mechanism of action: ———

D. Class:Angiotensin II receptor antagonists (ARB)
Mechanism of action: ———

E. Class:Vasodilators
Mechanism of action: ———

F. Class:Diuretics
Mechanism of action:———

Answer 18

Classification of anti-hypertensive by site or mechanism

A.Class:Sympatholytic drug
Mechanism of action: Blockade of sympathetic activities and decrease in peripheral resistance

B. Class:Calcium channel blockers (CCB)
Mechanism of action: inhibition of calcium influx in to arterial smooth muscle cells, resulting in a decrease in peripheral resistance.

C. Class: Angiotensin-converting enzyme Inhibitors(ACEI)
Mechanism of action: inhibits angiotensin converting enzyme that hydrolyzes angiotensin I (Inactive) to angiotensin II (Active)

D. Class:Angiotensin II receptor antagonists (ARB)
Mechanism of action: Inhibit Angiotensin II receptor, resulting in a decrease in peripheral resistance

E. Class:Vasodilators
Mechanism of action: Dilate arterial and venous blood vessels, resulting in a decrease in peripheral resistance.

F. Class:Diuretics
Mechanism of action:lower blood pressure by depleting the body sodium and reducing blood volume

Question 19

Classification of anti-hypertensive by site or mechanism of action

A. Sympatholytic drug
1. a) ß Adrenergic receptor antagonist (Beta blockers):
b) Cardio-selective/β1-selective blockers:
c) Non-selective β1/β2:

Answer 19

1. a) ß Adrenergic receptor antagonist (Beta blockers): the “olol”

◦ Atenolol
◦ Metoprolol
◦ Nadolol
◦ nebivolol
• Oxprenolol
• Pindolol
• Propranolol
• Timolol

b) Cardio-selective/β1-selective blockers:

▪Acebutolol ▪Atenolol ▪Betaxolol ▪Bisoprolol
▪ Esmolol
▪ Metoprolol ▪ Nebivolol

c) Non-selective β1/β2:

▪Carvedilol ▪Labetalol ▪Nadolol ▪Penbutolol
• Pindolol
• Propranolol • Sotalol
• Timolol

Question 20

Classification of anti-hypertensive by site or mechanism of action
A. Sympatholytic drug

2. α Adrenergic receptor antagonist (alpha blockers):
3. Mixed adrenergic antagonist:
4. Centrally acting agent/ α2 receptor agonist:
   5.Adrenergic neuron blockers:

Answer 20

Classification of anti-hypertensive by site or mechanism of action
A. Sympatholytic drug
2. α Adrenergic receptor antagonist (alpha blockers):
◦Doxazosin ◦Phentolamine ◦Indoramin ◦Phenoxybenzamine
• Prazosin. • Terazosin • Tolazoline

3. Mixed adrenergic antagonist:(CBL)
   ◦ Carvedilol ◦ Labetalol ◦ Bucindolol
4. Centrally acting agent/ α2 receptor agonist:
   • α –Methyldopa • Clonidine • Guanabenz
   • Guanfacine • Moxonidine

5.Adrenergic neuron blockers:
• Reserpine • Guanadrel

Question 21

Classification of anti-hypertensive by site or mechanism of action
B. Calcium channel blockers
1. Dihydropyridines:
2. Non-dihydropyridines:

Answer 21

Classification of anti-hypertensive by site or mechanism of action
B. Calcium channel blockers
the “dipine”

1. Dihydropyridines:(CA 4N LLIF)
   ◦ Amlodipine
   ◦ Cilnidipine
   ◦ Felodipine
   ◦ Isradipine
   ◦ Lercanidipine
   • Levamlodipine
   • Nicardipine
   • Nifedipine
   • Nimodipine
   • Nitrendipine
2. Non-dihydropyridines:
   • Diltiazem
   • Verapamil

Question 22

Classification of anti-hypertensive by
site or mechanism of action
C. Angiotensin-converting enzyme Inhibitors(ACEI):

Answer 22

Classification of anti-hypertensive by
site or mechanism of action
C. Angiotensin-converting enzyme Inhibitors(ACEI): the “pril”
(B CLEF PQRsT)
◦ Captopril
◦ Enalapril
◦ Fosinopril
◦ Lisinopril
◦ Benazepril
• Perindopril
• Quinapril
• Ramipril
• Trandolapril

Question 23

Classification of anti-hypertensive by
site or mechanism of action
D. Angiotensin II receptor antagonists:

Answer 23

Classification of anti-hypertensive by
site or mechanism of action
D. Angiotensin II receptor antagonists:(LOT VICE) “The sartans”
◦ Candesartan ◦ Eprosartan
◦ Irbesartan
◦ Losartan
• Olmesartan • Telmisartan • Valsartan

Question 24

Classification of anti-hypertensive by
site or mechanism of action
E. Vasodilators
1. Arterial vasodilators:
2. venous vasodilators:

Answer 24

Classification of anti-hypertensive by
site or mechanism of action
E. Vasodilators
1. Arterial vasodilators:(HDM)
◦ Hydralazine ◦ Minoxidil
◦ Diazoxide
2. venous vasodilators:
• Sodium nitroprusside

Question 25

Classification of anti-hypertensive by
site or mechanism of action
F. Diuretics
1. Loop diuretics:

2. Thiazide diuretics:
3. Thiazide-like diuretics:
4. Potassium-sparing diuretics:

Answer 25

LOOP DIURETICS:
(F BET)
Furosemide
Bumetanide
Ethacrynic acid
Torsemide

THIAZIDE DIURETIC:
(BEH)
Bendroflumethiazide
Epitizide
Hydrochlorothiazide

THIAZIDE LIKE DIURETICS:
(MIC )
Metalazone
Indapamide
Chlorthalidone

POTASSIUM SPARRING:
(SAT)
Spironolactone
Amiloride
Triamterene

Question 26

Potential drug targets:

1. vasomotor centre:
2. Vascular smooth muscle:
3. Heart:
4. Adrenal cortex:
5. Juxtaglomerular cells:
6. Kidney tubules:

Answer 26

Potential drug targets:

1. vasomotor centre
   Alpha 2-Adrenoceptor agonists
   (e.g. clonidine)
   Imidazoline receptor agonists
   (e.g. moxonidine)
2. Vascular smooth muscle
   ACE inhibitors drugs;( A drugs)
   Angiotensin receptor blockers.(A drugs)
   Calcium channel blockers (‘C’ drugs)
   Diuretics (‘D’ drugs)
   alpha1-Blockers (e.a. doxazosin)
3. Heart
   beta-Blockers
   (‘B’ drugs)
4. Adrenal cortex
   ACE inhibitors (A drugs)
   Angiotensin receptor blockers(A drugs)
   Mineralocorticoid antagonists
5. Juxtaglomerular cels
   B-blockers (B drugs)
   Renin inhibitors
6. Kidney tubules
   Diuretics (D’ drugs)
   ACE inhibitors ( A drugs)
   Angiotensin receptor blockers.(A drugs)

Question 27

Lines of treatment of primary
hypertension
“The initial step in treating hypertension may be ————.
*————restriction may be effective treatment for about how many of the patients with mild hypertension.
*——— reduction even without salt restriction normalizes blood pressure in up to —% of obese patients with mild to moderate hypertension.
Regular exercise may also be
helpful in some hypertensive patients.
*When non-pharmacologic approaches do not satisfactorily control blood pressure,———begins in addition to non-pharmacological approaches.

Answer 27

Lines of treatment of primary
hypertension
“The initial step in treating hypertension may be non-pharmacologic.
*Dietary salt restriction may be effective treatment for about half of the patients with
mild hypertension.
*Weight reduction even without salt restriction normalizes blood pressure in up to 70%
of obese patients with mild to moderate hypertension. Regular exercise may also be
helpful in some hypertensive patients.
*When non-pharmacologic approaches do not satisfactorily control blood pressure,
drug therapy begins in addition to non-pharmacological approaches.

Question 28

Lines of treatment of primary hypertension
▪The selection of drug(s) depends on various factors such as the ————, ———factors (——, ——, ——, etc.).
▪For most patients with mild hypertension and some patients with moderate hypertension monotherapy with either of the following drugs can be sufficient.these drugs include:

Answer 28

Lines of treatment of primary hypertension
▪The selection of drug(s) depends on various factors such as the severity of hypertension, patient factors (age, race, coexisting diseases, etc.).
▪For most patients with mild hypertension and some patients with moderate hypertension monotherapy with either of the following drugs can be sufficient.
▪ Thiazide diuretics
▪ Beta blockers
▪ Calcium channel blockers ,
▪ Angiotensin converting enzyme inhibitors
▪ Central sympatholytic agents

Question 29

Lines of treatment of primary hypertension
▪———- are preferred in young patients, high renin hypertension and patients with tachycardia or angina and hypertension.
▪Black patients respond well to —— and ——— than to ——- and ———
▪If mono-therapy is unsuccessful, ——————— may be used.
▪Thiazide diuretics may be used in conjunction with a ———-, ——— or an ————.

Answer 29

Lines of treatment of primary hypertension
▪Beta-blockers are preferred in young patients, high renin hypertension and patients with tachycardia or angina and hypertension.
▪Black patients respond well to diuretics and calcium channel blockers than to beta-blockers and ACE inhibitors.
▪If mono-therapy is unsuccessful, combination of two drugs with different sites of action may be used.
▪Thiazide diuretics may be used in conjunction with a beta-blocker, calcium channel blocker or an angiotensin converting enzyme inhibitor.

Question 30

Lines of treatment of primary hypertension
▪If hypertension is still not under control, a third drug e.g. ——— such as ——— may be combined.
▪When three drugs are required, combining a ———, a —— or an ——, and a ——— or ——— is effective.
▪The treatment of hypertensive emergencies is usually started with ——— given by ——— route at dose of — - —mg. In addition, parenteral use of ———, ———, ———, ———, ——— can be indicated.

Answer 30

Lines of treatment of primary hypertension
▪If hypertension is still not under control, a third drug e.g. vasodilator such as hydralazine may be combined.
▪When three drugs are required, combining a diuretic, a sympatholytic agents or an ACE inhibitor, and a direct vasodilator or calcium channel block is effective.
▪The treatment of hypertensive emergencies is usually started with furosemide given by parenteral route at dose of 20-40mg. In addition, parenteral use of diazoxide, sodium nitroprusside, hydralazine, trimethaphan, labetalol can be indicated.