Cardiac Drugs Flashcards
Why is hypertension a problem even if asymptomatic?
because it causes damage to the blood vessels in the kidney, heart, and brain, which contributes to end organ damage
Epidemiologic supports the idea that what factors contribute to the development of primary hypertension?
- genetics
- psychological stress
- environmental and dietary factors
Describe the risk of end organ damage across the ranges of blood pressure.
- risk is proportional to BP elevation
- risk is lowest at 115/75 and doubles with each increment of 20/10
How is a diagnosis of hypertension made?
- based on repeated, reproducible measurements of elevated blood pressure
- take the average of 2-3 measurements from separate occasions
List the important procedural aspects required to ensure you’re obtaining accurate blood pressure readings from patients.
- patient should sit quietly for five minutes before a reading and not talk during the measurement
- patient should avoid caffeine, exercise, or smoking for at least thirty minutes before
- patient should have voided bladder
- remove all clothing covering the location of cuff placement
- use a validated device with the correct cuff size
- support the patient’s arm
- at first visit, record BP in both arms and use the arm that gives the higher reading for subsequent readings
What are the BP cutoffs for normal, elevated, HTN 1, and HTN 2?
- normal: systolic less than 120 and diastolic less than 80
- elevated: systolic of 120-129 and diastolic less than 80
- HTN 1: systolic of 130-139 or diastolic 80-89
- HTN 2: systolic over 140 or diastolic over 90
What is the recommendation for treatment or follow up for patients that meet the criteria for normal BP, elevated BP, HTN 1, and HTN 2?
- normal: evaluate yearly
- elevated: recommend healthy lifestyle changes and reassess in 3-6 months
- HTN 1: assess 10 year risk for heart disease and stroke; if less than 10% treated as elevated; if more than 10% or patient has CVD, DM, or CKD recommend lifestyle modification and 1 BP lowering medication
- HTN 2: recommend healthy lifestyle changes and 2 BP meds of different classes
Describe how African Americans are disproportionately affected by hypertension.
- higher proportion are sensitive to salt in the diet
- more like to have hypertension
- more like to have renal complications or end-stage disease due to hypertension
How does the treatment of African Americans with hypertension differ from that of whites?
African Americans typically respond well to calcium channel blockers and diuretics and don’t respond as well to ACE inhibitors, ARBs, or beta blockers
How does the pathophysiology of hypertension in older adults differ from that seen in younger populations?
- BP = CO x TPR
- in older adults, TPR tends to contribute more to hypertension
- in younger adults, CO tends to contribute more
- this can influence the drugs used to treat these two populations
What are the positive benefits of lifestyle modification in those with hypertension?
- it lowers cardiovascular risk
- and it can reduce the number and dose of antihypertensive meds required for treatment
Why is compliance a challenge when treating hypertension?
because it is not normally felt by the patient and they are asymptomatic
What is the most common cause of treatment failure for those with hypertension?
non-compliance
Which thiazide is most used in the treatment of hypertension? Why?
Chlorothalidone because of it’s long half-life and proven reduction of CVD
ACE inhibitors induce hypotension in several ways. Which BP lowering mechanism is most effective?
decreasing peripheral vascular resistance
