Cardiology - Hypertension Medications

Question 1

How do thiazide diuretics work? When are they most effective?

Answer 1

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.

Question 2

Thiazide Diuretics - Common side effects?

Answer 2

Dehydration, postural hypotension

Hyponatraemia, hypokalaemia, hypercalcaemia

Gout

Impaired glucose tolerance

Impotence

Question 3

Thiazide Diuretics - Rare side effects?

Answer 3

Pancreatitis
Agranulocytosis
Thrombocytopenia
Photosensitivity rash

Question 4

Action and role of amiloride and triamterene in treating hypertension?

Answer 4

Inhibit ENaC in distal tubule

Add to thiazide to rpevent hypokalaemia

Question 5

When are loop diuretics potentially used for hypertension treatment?

Answer 5

In very low GFR or heart failure

Question 6

Additional benefits to ACEi and ARBs in treatment of hypertension?

Answer 6

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

Question 7

Which antihypertensive is associated with a decreased risk for developing diabetes in high risk hypertensive patients

Answer 7

Valsartan

Question 8

What is aliskiren? How can it be used in treating hypertension?

Answer 8

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

Question 9

Name the direct renin inhibitor that can be added to thiazide or CCBs in treating hypertension

Answer 9

Aliskiren

Question 10

When are aldosterone antagonists particularly good in treatment of hypertension?

Answer 10

In LOW RENIN primary hypertension, resistant hypertension and primary aldosteronism

Question 11

How does beta blockers lower blood pressure?

Answer 11

• reduce heart rate and contractility
• CNS effect
• inhibit renin release

Question 12

Which beta blockers act on both beta receptors and peripheral alpha receptors?

Answer 12

Labetolol

Carvedilol

Question 13

Which beta blocker has an additional vasodilator action due to enhancement of nitric oxide action?

Answer 13

Nebivolol

Question 14

How do alpha-adrenergic blockers reduce blood pressure?

Answer 14

Decrease peripheral vascular resistance

Question 15

How do sympatholytic agents in hypertension treatment decrease blood pressure?

Answer 15

Centrally acting alpha2 sympathetic agonists (ie: clonidine, methyldopa) inhibit sympathetic outflow –> reduce peripheral resistance

Useful in autonomic dysfunction

Question 16

How do calcium channel blockers reduce blood pressure?

Answer 16

Block L-channels to decrease intracellular calcium and blunt vasoconstriction

Question 17

What are the two direct vasodilators?

Answer 17

Hydralazine

and Minoxidil

Question 18

How does hydralazine work as an antihypertensive?

Answer 18

Hydralazine is a direct vasodilator. It is also an antioxidant and enhances nitric oxide.

Question 19

How does minoxidil work as an antihypertensive? When is it best used? What are two important side effects?

Answer 19

Very potent direct vasodilator.

Used in renal insufficiency with resistant hypertension.

S/E: hypertrichosis and pericardial effusion

Question 20

How does age impact your choice of antihypertensive?

Answer 20

Younger patients are more responsive to beta blockers and ACE inhibitors

Older patients >50yrs are more responsive to diuretics and CCBs

Question 21

In a patient with history of stroke and TIA what is the best antihypertensive to use for their high blood pressure?

Answer 21

CCBs have prevention benefit

PROGRESS study showed benefit with perindopril

Question 22

In a patient with history of CKD which is the best antihypertensive to use for their high blood pressure?

Answer 22

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.

Question 23

In a patient with a history of diabetes which is the best antihypertensive to use for their high blood pressure?

Answer 23

ACEi or ARB
or Aliskiren
–> these all decrease proteinuria and delay ESRF

Question 24

In African American patients which is the best antihypertensive to use for their high blood pressure?

Answer 24

ACEi is more effective than BB or diuretics to SLOW decreasing eGFR