Drugs Used in the Treatment of Hypertension Flashcards
What is mean pressure of blood dictated by
Resistance in small vessels
What property of the wall of arteries is important in regulating blood pressure
Elasticity
What is the purpose of elastic recoil of the arteries during ventricular relaxation (diastole)
To maintain the driving pressure, sending blood forwards into the rest of the circulatory system
Why does your systolic pressure increase as you age
Your arteries become stiffer
What are the effects of high or inadequately controlled blood pressure
There are cardiac, cerebrovascular, vascular as well as other effects of high or inadequately controlled blood pressure
What are the cardiac effects of high blood pressure
Heart attack, angina and cardiac failure
What are the cerebrovascular effects of high blood pressure
Stroke, TIA (transient ischaemic attack), multi-infarct dementia
What are the vascular effects of high blood pressure
Peripheral vascular disease, aortic aneurysm/rupture.
What are the other effects of high blood pressure (not cardiac, cerebrovascular or vascular)
Renal damage, retinopathy
What is the rate of genetic heritability of hypertension
30-50%
On what organ do most of the genes which affect blood pressure act
The kidney
What organ is important in regulating blood pressure
The kidney
What system within the kidney do genetic mutations affect
The renin-angiotensin system which is involved in vasoconstriction and fluid retention or loss (involving angiotensin II, aldosterone, ADH)
What factors can reduce hypertension
- reduce salt intake
- increase exercise
- reduce saturated fat intake
- reduce smoking
- reduce alcohol intake
- increase potassium intake
- increase nitrate intake
At what stage is high blood pressure considered to be pathological
When treatment does more good than harm.
What drugs are the primary 4 drugs used to treat hypertension
ABCD
- ACE inhibitors or angiotensin II receptor blockers
- Beta-blockers
- Calcium entry blockers
- Diuretics
What is the ending of most ACE inhibitors
-pril
What is the ending of most angiotensin II receptor blockers
-sartan
What is the ending of most beta-blockers
-olol
What are four other drugs (not ABCD) used to treat hypertension
Alpha-adrenoceptor blockers, potassium channel openers, loop diuretics, mineralocorticoid antagonists.
What is an example of an alpha adrenoceptor blocker than may be used in the treatment of hypertension
Doxazosin
What is an example of a potassium channel opener that may be used in the treatment of hypertension
Minoxidil
What are two examples of loop diuretics which may be used in the treatment of hypertension
Frusemide, torasemide
What are two examples of mineralocorticoid antagonists which may be used in the treatment of hypertension
Spironolactone, eplerenone
Who would you most likely treat with ACE inhibitors/angiotensin II receptor blockers or beta blockers and why
Younger Eurasian people because they have the most renin.
Who would you most likely treat with calcium channel entry blockers or diuretics and why
Older afro-Caribbean people because they have the least renin.
What hypertension drugs can be used in combination
A+C or A+D and if required A+C+D
Give three examples of ACE inhibitors
Enalapril, Lisinopril, Ramipril
Give two examples of angiotensin II receptor blockers
Iosartan, Candesartan
Give three examples of beta-blockers
Atenolol, Metoprolol, Bisoprolol
Give two examples of calcium antagonists
Nifedipine, Amiodipine
Give one example of a diuretic
Bendroflumethiazide
What is the mechanism of action of ACE inhibitors
They inhibit angiotensin converting enzyme which is involved in the formation of angiotensin II which is a vasoconstrictor. They therefore block the renin-angiotensin system and dilate arteries.
What is the mechanism of action of beta-blockers
They block beta adrenoceptors in the heart and reduce cardiac rate and output.
What is the mechanism of action of calcium antagonists
They block the entry of calcium and result in dilatation of arteries.
What is the mechanism of action of thiazide diuretics
They inhibit Na+-Cl- symport and dilate arteries and veins. The result is loss of salts.
What are the side effects of ACE inhibitors
Cough and renal dysfunction
What are the side effects of angiotensin II receptor blockers
There are few
What are the side effects of beta-blockers
Wheeze, cold peripheries, exercise intolerance, heart block, diabetes
What are the side effects of calcium antagonists
Headaches, flushing, ankle swelling, tachycardia
what are the side effects of diuretics
Impotence, rashes, low sodium, low potassium, high glucose
Why may treatment for hypertension be ineffective
Due to the wrong combination of drugs - this will not work, inappropriately low doses, renal causes.
What is the polypill
A possible new hypertension medication. Made up of low concentrations of lots of different medications to reduce side effects.
What are the 5 drugs which make up the polypill
ACE inhibitor, beta-blocker, diuretic, aspirin and statin.
