Chapter 50: Drugs for Hypertension Flashcards
what are the 4 risk factors for hypertension
- diabetes mellitus
- chronic kidney disease
- low level of consumption of fresh fruits and vegetables
- sedentary behaviour
out of office measurement of blood pressure is reccomended for all adults with
- high BP in office to rule out white coat hypertension
- suspected hypertension yo rule out masked hypertension
normal blood pressure
systolic BP <120 and diastolic BP < 80
elevated BP
systolic BP of 120-129 and diastolic <80
hypertension stage 1
systolic BP 130-139 or dialstolic 80-89
hypertesnion stage 2
systolic BP >140 or diastolic BP >90
what is the target blood pressure for someone with diabetes
<130
consequences of hypertension
- increased risk of stroke and ischemic heart disease mortality
- for every 20 systolic BP; risk of dying doubles
- for every 10 diastolic BP; risk doubles
Primary (essential) hypertension
- no identifiable cause
- chronic, progressive disorder
- population: older adults, african Canadians, postmenopausal women
- treated no cured
secondary hypertension
- identifiable primary cause
- possible to treat the cause directly
- some individuals can be cured (hypertension during pregnancy or a tumour)
masked hypertension
- patients BP is less than 140/90 in a medical setting but is hypertensive at home
white coat hypertension
- patients BP is less than 140/90 at home but is hypertensive in a medical setting
- associated with anxiety and nervousness
hypertension is a significant risk factor for
- cerebrovascular disease
- coronary artery disease
- heart failure
- renal failure
- peripheral vascular disease
- dementia
- atrial fibrillation
- kidney disease
major cardiovascular risk factors
- cigarette smoking
- physical inactivity
- dyslipidemia
- diabetes
- microalbuminuria
- advances age (older 55 men; older 65 women)
- family history
lifestyle modifications for hypertension
- sodium restriction
- DASH eating plan
- alcohol restriction
- aerobic exercise / weight reduction
- smoking cessation
- maintenance of potassium and calcium intake
- relaxation therapies
sodium intake should be
<2000 mg/day
how much physical activity should someone do
30-60 min 4-7 days/week
appropriate alcohol intakw
0-2 drinks per day
stress management
CBT and relaxation techniques
what is healthy BMI
18.5-24.9kg/m
healthy waist circumference
men <102cm
women <88cm
arterial pressure =
cardiac output x peripheral resistance
cardiac output is influenced by
- heart rate
- myocardial contractility
- blood volume
- venous return
what are the systems that help regulate blood pressure
- SNS: sympathetic baroreceptor reflex
- RAAS
- kidney: renal regulation of blood pressure
what are the sites of drug action
- brainstem
- sympathetic ganglia
- terminals of adrenergic nerves
- beta 1 adrenergic receptors on the heart
- alpha 1 adrenergic receptors on blood vessels
- renal tubules
- RAAS
what are the classes of hypertensive drugs
- Diuretics
- Sympatholytics (antiadrenergic drugs)
- direct acting vasodilators (hydralazine and minoxidil)
- calcium channel blockers (diltiazem, verapamil)
- drugs that supress RAAS (ACE inhibitors, ARBS, aldosterone antagonists)
patients without compelling inducations will be put on which drug
long-acting thiazide-like diuretics
- Indapamide
or single pill combinations
patients with compelling indications will be put on which drugs
- beta blocker
- ACE
- ARB
- CCB
- duiretic
What drugs should be used in patients with renal disease
ACE or ARB
what drugs should be used in patients with diabetes
may need multiple drugs
what drugs should be used in african Canadians
diuretics are first choice
what drugs should be avoided in females
ACE/ARB
what drugs should be used in older adults
- start with low dose diuretic
what are ways to promote adherence
- educate the patient
- teach self-monitoring
- minimize side effects
- establish a collaborative relationship (patient centered care)
- simplify the regimen
- other measures (motivational interviewing)
possible reasons for poor response to treatment
- adherence (dietary, activity, meds)
- obestity, tobacco, alcohol, sleep apnea, chronic pain
- suboptimal treatment dose
- volume overload- high sodium intake
- drug interactions
drugs for hypertensive emergencies
- sodium nitroprusside [Nitropress]
- Labetalol
sodium nitroprusside [nitropress]
- continuous IV infusion via pump
- direct acting vasodilator
Labetalol
- alpha/beta blocker
- slow IV
what drugs shoul dbe used for hypertension during pregnancy
- labetolol
- methydopa
- LA nifedipine
- beta blockers
what drugs are contradicted during pregnancy
- ACE
- ARB
- DRI
what drugs are use for preeclampsia and eclampsia
- hydralazine
- magnesium sulfate
what may aggravate low blood pressure q
- hot tubes, showers, baths, hot weather, prolonged sitting or standing, physical exercise, and alcohol ingestion
