Cardiology - Hypertension Medications Flashcards
How do thiazide diuretics work? When are they most effective?
Inhibit Na/Cl pump in DCT –> increases Na excretion.
Long term also act as vasodilators.
Most effective if added to beta blockers, ACEi or ARBs.
Less effective when added to calcium channel blockers.
Thiazide Diuretics - Common side effects?
Dehydration, postural hypotension
Hyponatraemia, hypokalaemia, hypercalcaemia
Gout
Impaired glucose tolerance
Impotence
Thiazide Diuretics - Rare side effects?
Pancreatitis
Agranulocytosis
Thrombocytopenia
Photosensitivity rash
Action and role of amiloride and triamterene in treating hypertension?
Inhibit ENaC in distal tubule
Add to thiazide to rpevent hypokalaemia
When are loop diuretics potentially used for hypertension treatment?
In very low GFR or heart failure
Additional benefits to ACEi and ARBs in treatment of hypertension?
Both improve insulin action (so can counter the effects of diuretics)
Valsartan is associated with a decreased risk for developing diabetes in high risk hypertensive patients
Which antihypertensive is associated with a decreased risk for developing diabetes in high risk hypertensive patients
Valsartan
What is aliskiren? How can it be used in treating hypertension?
A direct renin inhibitor
Acts as a nonpeptide competitive inhibitor of the enzymatic activity of renin
Monotherapy is INFERIOR to ACEi or ARB in lowering BP
Can be added to thiazide or CCB
Name the direct renin inhibitor that can be added to thiazide or CCBs in treating hypertension
Aliskiren
When are aldosterone antagonists particularly good in treatment of hypertension?
In LOW RENIN primary hypertension, resistant hypertension and primary aldosteronism
How does beta blockers lower blood pressure?
- reduce heart rate and contractility
- CNS effect
- inhibit renin release
Which beta blockers act on both beta receptors and peripheral alpha receptors?
Labetolol
Carvedilol
Which beta blocker has an additional vasodilator action due to enhancement of nitric oxide action?
Nebivolol
How do alpha-adrenergic blockers reduce blood pressure?
Decrease peripheral vascular resistance
How do sympatholytic agents in hypertension treatment decrease blood pressure?
Centrally acting alpha2 sympathetic agonists (ie: clonidine, methyldopa) inhibit sympathetic outflow –> reduce peripheral resistance
Useful in autonomic dysfunction
How do calcium channel blockers reduce blood pressure?
Block L-channels to decrease intracellular calcium and blunt vasoconstriction
What are the two direct vasodilators?
Hydralazine
and Minoxidil
How does hydralazine work as an antihypertensive?
Hydralazine is a direct vasodilator. It is also an antioxidant and enhances nitric oxide.
How does minoxidil work as an antihypertensive? When is it best used? What are two important side effects?
Very potent direct vasodilator.
Used in renal insufficiency with resistant hypertension.
S/E: hypertrichosis and pericardial effusion
How does age impact your choice of antihypertensive?
Younger patients are more responsive to beta blockers and ACE inhibitors
Older patients >50yrs are more responsive to diuretics and CCBs
In a patient with history of stroke and TIA what is the best antihypertensive to use for their high blood pressure?
CCBs have prevention benefit
PROGRESS study showed benefit with perindopril
In a patient with history of CKD which is the best antihypertensive to use for their high blood pressure?
ACCOMPLISH showed benefit with benazepril+amlodipine compared to benazepril+HCT to prevent CVS events, and preventing worsening of CKD or ESRF
But they were equal at reducing BPs.
In a patient with a history of diabetes which is the best antihypertensive to use for their high blood pressure?
ACEi or ARB
or Aliskiren
–> these all decrease proteinuria and delay ESRF
In African American patients which is the best antihypertensive to use for their high blood pressure?
ACEi is more effective than BB or diuretics to SLOW decreasing eGFR