CVS

Question 1

Hypertension

Answer 1

Systolic => 140
Diastolic => 90
Measured at least 3 seperate occasions
“Pathologically elevated and sustained BP”
- Risk factor for
1. CVS disease - CAD, MI, HF, cardiomyopathy
2. Cerebrovascular accidents - stroke
3. Renal failure (acute and CHF)
4. Retinopathy
5. Vascular disease - PAD (PE2 and PGI2)
6. Sexual dysfunction in males

Question 2

What controls
Diastolic BP
Systolic BP

Answer 2

• TPR - arterial to venous (arterioconstriction - pooling)
• CO

Question 3

Treatment of hypertension

Answer 3

Lifestyle modification

Pharmacological treatment
1. Central sympatholytic drugs - alpha and beta blockers
2.

Question 4

Pharamcological treatment of hypertension

Answer 4

1. Centrally acting sympatholytic drugs Pre gangilionic
   - Clonidine, alpha methyl dopa (replaces dopa), gaunfacine and gaunsbenzin
   Auto-inhibitory alpha 2 receptors
2. Ganglionic blockers
   - Hexamethonium not used non-selective
3. Post ganglionic
   - Guandrel - enters vesicle and replaces NA causes it to be broken down by MAO and COMT
   - Reserpine - does not enter vesicle blocks monoamine transport system dopamine does not enter vesicle therefore no NA
   - Metyrosine - selfish block tyrosine hydroxylase no tryosine to dopa coversion
4. Alpha, beta and mixed blockers
   Alpha
   - Non-selective amine family phenoxybenzamine phentolamine and dibenamine
   Postural hypotension + reflex tachycardia
   - Selective -zosin prozaosin, doaxsoin and terazosin
   Postural hypotension
   Beta
   - Non-selective Propanolol Pindiol Timdol
   -Selective Atenonol Bisprolol Mesoprolol
   Mixed
   - Labetolol
   - Carvediolol
5. Direct acting vasodilators
   - Aretriolodiltor + venodilator - nitroprusside
   - Aretriolodilator - hydralaizne, minoxidil and diazoxide
   Minoxidil + diazoxide - open ATP sensitive K+ channels hyeprpolarization and electronegative makes it harder to reach threshold decreases contraction
   Nitroprusside + hydralazine - phosphorylate light chain kinase inhibiting it so it does not phospyralte light chain mysoin to intreact with actin and therefore no muscle contraction
6. Calcium channels blockers
   L- type calcium channels
   Mycocardail cells have voltage gated calciuk channels which release dtored intracellular calcium
   - Heart - verpamil
   - Arterial smooth muscle - nifedipine and amlodipine
   - Heart + smooth muscle - dilitazim
7. ACE inhibitors
   pril family
   - Lisinopril, benzapril and captopril
   No angiotensin to angiotensin II
   - No angiotensin II
   - Prevents bradykinin degradation (dry cough and severe angiodema)
   Action of angiotensin II
   - Kidney - RAAS and increase Na+
   - Hypothalamus thirst
   - Posterior pituitary ADH
   - Blood vessel smooth muscle of arterioles and venues vasoconstriction
   - Sympathetic system
   ACE inhibitors are nephroprotective
   ACE inhibitors and ARBs are tetratogenic and fetogenic do jot gige to pregnant
8. ARBs
   Satan family RB
   - sartan
   Losartan and telmimsartan
9. Diuretics
   - Loop -one family
   Ascending loop of henle
   Block Na/Cl/K cotransporter
   - smide family
   Furosmide, torsemdie bumtanide and etharyic acid
   - Thiazide
   Early DCT increase Na+/Cl- excretion cotransporter and vasodilation
   - Potassium sparing
   Inhibit Na+ reabsorption and K+ excretion
   Inhibit sodium channels - amiloride and triamterene
   Inhibit aldosterone - spirolactone (steroid) and epterenone