Anti-hypertensive Drugs Flashcards
What is hypertension
140/90
- generally asymptomatic
- risk increases with age
Major risk factors for hypertension
- stroke
- coronary artery disease
- renal disease
- CVS death risk doubles
- retinal disease
Treatments
- lifestyle - diet low salt, smoking, weight loss, exercise, reduced alcohol
- drugs (ABCD)
thiazide
-bendrofluzide
- both inhibits Na/CL transporter in DCT so it stops absorption of sodium
- and also it makes you pee out salt
- also has a vasodilator effect
- BP is reduced due to vasodilator property
Why give ace inhibitor with thiazide diuretic?
ace inhibitor blocks the reactivation of the RAAS system that the diuretic may cause
- together these work well together
- can get single tablets that combine these
thiazide side effects
increase glucose, urate,
decrease sodium, potassium, magnesium,
-diuresis (excessive urine)
-use low dose to stop side effects
Frusemide
- loop diuretic
- inhibit Na, K, L co-transproter
- potent diuretic
- good for heart failure - when you want to get rid of excess fluid when patient is overloaded
- dont have much bp lowering property unless use it with an ace inhibitor
Spirinolactone
- Potassim sparing diuretic
- aldosterone antagonist
- acts in the collecting duct
- normally aldosterone will increase na/k atpase pump
- howveer this is blocked, so get less sodium absorption and more potassium excretion
- have good BP lowering effects
- used for people where hypertension therapy is resistant
- can cause hyperkalemia
alpha blockers
3rd line therapy - doxazosin - vasodilator
When do we need to treat blood pressure
- either when it gets to a very high level
- or when there is something else wrong e.g Coronary artery disease, cerebrovascular disease, LVH, heart failure, DM
- also if you work out someones 10 year Cardiovascular risk
-differnt target levels for BP
Young vs old treatment
Young - ace inhibitor (want to block renin)
Older - calcium channel blocker or diuretic (need something independent of RAAS system)
2nd - if that is not lowering, then add something form other side ace + calcium channel blocker + diuretic
diuretic + ace inhibitor + vasodilator
Good combination - bendrofluazide + cilazapril + felodipine
Sensible drug combinations
Hypertension + heart failure
Hypertension + angina/heart failure
hypertension + heart failure
hypertension + prostatism
Hypertension + heart failure - Ace
Hypertension + angina/heart failure - Beta blocker
hypertension + heart failure - Diuretic
hypertension + prostatism - alpha blocker
Pregnancy and hypertension
beta blocker - labetalol
calcium antagonist - nifedipine
vasodilator - hydralazine
DO NOT USE
- ace inhibitor
- diuretics
