Drugs used for treatment of Hypertension 1

Question 1

List the major risk factors for hypertension

Answer 1

• Levels of systolic and diastolic BP
• Smoking
• Dyslipidaemia:
• Total cholesterol > 5.1 mmol/l, OR
• LDL > 3 mmol/l, OR
• HDL men < 1 and women < 1.2 mmol/l
• Diabetes mellitus
• Men > 55 years
• Women > 65 years
• Family history of early onset of CVD:
• Men aged < 55 years
• Women aged < 65 years
• Waist circumference: abdominal obesity:
• Men ≥ 102 cm
• Women ≥ 88 cm
• The exceptions are South Asians and Chinese: men: > 90 cm and women: > 80 cm.

Question 2

List the target organ damage for Complications of long-term uncontrolled hypertension

Answer 2

Target organ damage (TOD):
* Left ventricular hypertrophy
* Hypertensive retinopathy
* Microalbuminuria or positive urine dipsticks for albuminuria or elevated albumin
creatinine ratio
* Elevated creatinine level (or eGFR <60ml/min)

Question 3

List the assocaited clinical conditions under the complication of long-term uncontrolled hypertension

Answer 3

Associated clinical conditions:
* Ischaemic heart disease / MI
* Heart failure
* Stroke / transient ischemic attack(TIA)
* Chronic kidney disease
* Peripheral arterial disease

Question 4

List the recommended lifestyle modification of hypertension

Answer 4

1. Weight reduction
2. Dash diet (dietary approaches to stop hypertension)
3. Dietary sodium
4. Physical activity
5. Moderation of alcohol
6. Tobacco

Question 5

explain the recommendation about Tobacco

Answer 5

complete cessation

Question 6

Explain the recommendation for moderation of alcohol

Answer 6

No more than 2 drinks per day males, 1 drink females
2-4

Question 7

explain the recommendations about physical activity

Answer 7

brisk walking for 30 minutes per day on most days
4-9

Question 8

explain the recommendations for dietary sodium

Answer 8

<100 mmol or 6g (around 1 level teaspoon) of NaCL/day (dietician advice)
2-8

Question 9

explain the recommendations for dash diet

Answer 9

decrease saturated fat and total fat, increase fruit and vegetable (dietician advice)
8-14

Question 10

explain the recommendations for weight reduction

Answer 10

BMI 18.5-24.9 Kg/m2
5-20 per 10kg

Question 11

list 2 factors that influences blood pressure

Answer 11

CO
PVR

Question 12

List the classes of antihypertensives

Answer 12

• Beta-blocking agents
• Agents acting on renin-angiotensin system
• Vasodilators
• Alpha-adrenoceptor antagonists (doxazosin)
• Calcium-channel blockers
• Agents acting on arterial smooth muscle
• Diuretics
• Centrally acting agents

Question 13

List the agents that act on arterioler smooth muscle

Answer 13

Hydralazine
Minoxidil

Question 14

explain the MoA of hydralizine

Answer 14

Uncertain mechanism of action: relax arteries and arterioles = vasodilation =
↓peripheral resistance = ↓ BP accompanied by reflex tachycardia and ↑
CO (interferes with action of inositol triphosphate on Ca+ release from
the sarcoplasmic reticulum)

Question 15

explain the indications for hydralizine

Answer 15

Indications: 4th line treatment for hypertension (low doses in combination
with b-blocker), supplementary tx in chronic cardiac failure

Question 16

explain the adverse effects of hydralizine

Answer 16

Adverse effect: long-term use can cause immune disorder resembling SLE

Question 17

Indicated for HF in patienst of african origin in combination with?

Answer 17

Long-acting nitrate

Question 18

explain the adverse effect of minoxidil

Answer 18

Adverse effect: marked salt and water retention (NOT for heart failure),
prescribed with a loop diuretic, hirsutism

Question 19

explain what does Minoxidil do?

Answer 19

Direct acting vasodilator(by activating K+ channels), increases CO and
accompanied by tachycardia
Potent and long-acting vasodilator
Last line unresponsive/refractory hypertension (NOT used as
monotherapy, concurrent diuretic and b-blocker often required)