Chapter 47: Treatment of Hypertension Flashcards
What is essential hypertension? What is secondary hypertension? What is prehypertension?
Essential (primary) hypertension: has no identifiable cause. This is chronic, progressive, lifelong, and strikes older adults. Occurs most frequently with African Americans, Mexicans, Americans, and post-menopausal women.
Secondary hypertension: Hypertension with an identifiable cause. This can be treated directly and may be cured. Causes: alcohol abuse, kidney disease, sleep apnea, use of methylphenidate or glucocorticoids.
Prehypertension: 120-139/80-89
How does one make a diagnosis of hypertension in a patient?
Three occasions separated by time. Either elevated systolic or diastolic qualifies.
What changes are recommended for a patient with hypertension?
salt restriction, DASH diet, alcohol restriction, aerobic exercise, smoking cessation, and maintenance of potassium and calcium intake.
Why does blood pressure rise as a person ages?
Blood pressure increases with age as the vessels lose4 elasticity and may become clogged with plaque.
What diseases combined with hypertension markedly increases the risk of death from cardiovascular events?
Heart disease, stroke, chronic kidney disease, peripheral artery disease, and retinopathy markedly increase the risk of death from cardiovascular events.
What drugs are preferred in patients with hypertension who have no “compelling indications” for a particular drug?
Thiazide diuretics are the first line treatment for treating hypertension in patients who do not have compelling indications.
What are “compelling indications”?
Compelling indications include: renal disease, diabetes, and heart failure.
Why might an ACE inhibitor be prescribed for a patient with DM?
ACE inhibitors are a first line of defense for patients who have HTN and DM. These drugs prevent the formation of ANGIOTENSIN II which prevents angiotensin vasoconstriction and aldosterone-mediated volume expansion.
** ACE inhibitors are used in pts with DM who are NOT hypertensive as they PROTECT the kidneys from ongoing damage. (they slow the progression of kidney disease.)
What are the adverse effects of Beta blockers, ACE inhibitors, and Calcium channel blockers?
Beta blockers: bradycardia, decreased AV conduction, and reduced contractility, depression, insomnia, bizarre dreams, mask signs of hypoglycemia, and cause sexual dysfunction.
ACE inhibitors: Persistent cough, first dose hypotension, angioedema, and hyperkalemia.
Calcium Channel Blockers: Reflex tachycardia, flushing, dizziness, headache, peripheral edema, and constipation
Which antihypertensives should not be used in pregnancy?
ACE inhibitors, (Angiotensin Receptor blockers) ARBs, and (Direct Renin Inhibitors) DRIs are all contraindicated for use in pregnancy.
Which drugs would you give IV to a patient who has preeclampsia/eclampsia to lower BP in a hurry? Which drug is used to prevent preeclamptic seizures?
Labetolol is used in this case. Magnesium Sulfate is the drug of choice to treat seizures caused by eclampsia.
