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Fundamentals of Pharmacology > Hypertension 1 > Flashcards

Hypertension 1 Flashcards

1
Q

What is Systolic BP?

A
  • Pressure of the blood against the artery walls when the heart contracts
  • 120mmHg
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2
Q

What is Diastolic BP?

A
  • Pressure against the artery walls when the heart relaxes between beats
  • 80mmHg
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3
Q

Define Prehypertension

A
  • Systolic between 121-139mmHg

OR

  • Diastolic between 81-89mmHg
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4
Q

Define Hypertension

A
  • Systolic 140 or above

OR

  • Diastolic 90 or above
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5
Q

Function of Arteries

A

Deliver molecules to tissues

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6
Q

Function of Veins

A

Take molecules from tissues

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7
Q

What is the importance of proper systolic and diastolic BP?

A
  • Blood needs to be pumped out of the heart as well as taken into the heart
  • Proper values of both systolic and diastolic pressure are crucial for proper function of the vascular system
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8
Q

What is the function of Baroreceptors and where are they located?

A
  • Detects changes in BP
  • Location:
    • internal carotids
    • aortic arches
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9
Q

What is the function of Chemoreceptors and where are they located?

A
  • Detects changes in pH (H+, O2, CO2)
  • Location
    • internal carotids
    • aortic arches
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10
Q

What does a low pH indicate?

A

Inefficient blood flow and oxygenation

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11
Q

What are major factors affecting BP?

A
  • Peripheral resistance
  • Cardiac output
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12
Q

The amount of blood pumped is dependent on?

A
  1. Heart rate
  2. Heart contractility
  3. Heart muscle health (metabolism)
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13
Q

Define Cardiac Output

A
  • The volume of blood pumped by the heart per minute (mL of blood/min)
  • The more blood pumped into the system, the higher the BP is
  • CO = HR x SV
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14
Q

Define Peripheral Resistance

A
  • Hydrostatic ‘back pressure’ working against heart attempt to pump the blood into the CV system
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15
Q

What are the important hydrostatic parameters affecting BP?

A
  • Proper blood flow would depend on hydrostatic parameters
    1. Force by which blood is pushed through the system
    2. Volume of blood in the system
    3. Diameter of conducting vessels
      • achieved by sympathetic nervous system
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16
Q

What are the treatment aims of hypertension?

A
  • Decrease arterial BP by decreasing:
    • cardiac function-related (CO)
    • blood volume (Peripheral resistance)
  • Drugs affecting diameter of arteries (vasodilators) aren’t used in treatment of high BP but for other CV conditions e.g. angina
    • could impact BP therapy
17
Q

Discuss Primary (Essential) Hypertension

A
  • Raised blood pressure with ‘no clear single identifiable cause’
  • Factors are involved with blood pressure control including:
    • adrenergic nervous system
    • the RAAS
    • renal function changes
    • hormonal factors (e.g. vasopressin, adrenal hormones)
    • vascular endothelium
    • haemodynamic changes (e.g. changes in CO and peripheral vascular resistance)
18
Q

Discuss Secondary Hypertension

A
  • Refers to elevated blood pressure that can be attributed to a specific cause
  • Causes:
    • pregnancy
    • pheochromocytoma
    • aorta constriction
    • hyperthyroidism
    • Cushing’s syndrome
    • Primary hyperaldosteronism
    • Renoparenchymal diseases of the kidney
    • Renovascular disease
  • Certain prescription, non-prescription and natural health products can also precipitate or worsen hypertension
    • treat primary cause
19
Q

Discuss Resistant Hypertension

A
  • Blood pressure that remains above treatment goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic
  • If patient has blood pressure controlled with 4 or more medications = resistant hypertension
20
Q

What is the treatment aim of antihypertensive medications?

A
  • To reduce the risk of CVD, target organ damage and mortality associated
  • May be achieved by lowering SBP to <140mmHg and lower DBP to <90mmHg
  • Majority of patients require a combination of lifestyle modifications and medications to achieve target blood pressures
21
Q

How do you calculate BMI and what is a healthy BMI range?

A

BMI = weight (kg)/height (m)2

  • Healthy range: 18.5-22.9
  • Obese: 27.5 and above
22
Q

What are non-modifiable risk factors?

A
  • Increasing age (>55y)
  • male gender
  • family history of premature CVD (men <55 years or women <65 years) in a primary/first-degree relative
23
Q

What are modifiable risk factors?

A
  • Sedentary lifestyle
  • Poor dietary habits
  • Smoking
  • Dyslipidaemia
  • Stress
  • Abdominal obesity (BMI >25; waist circumference >102 cm in men or >88cm in women)
  • Impaired glucose tolerance or diabetes mellitus
24
Q

Target organ damage

A
  • Cerebrovascular disease
  • Coronary artery disease
  • Chronic renal disease
  • Peripheral artery disease
25
Q

What are lifestyle modifications in hypertension treatment?

A
  • Weight reduction
  • Physical activity
  • Healthy diet
  • Salt intake
  • Alcohol intake
  • Smoking
  • Emotional Stress
26
Q

What is the MOA of aldosterone?

What happens if aldosterone receptors are blocked?

A
  • Upregulates expression of epithelial sodium channels (ENaC) in the collecting duct, increasing Na+ absorption as well as Na+/K+ pump level
  • Overall effect: increase in BP
  • If aldosterone receptors are blocked, blood pressure decreases
27
Q

What happens when reuptake of Na+ from urine?

A

Reuptake of Na+ from urine brings water with it into the blood and raises BP

28
Q

Define Preload

A

Volume of blood in ventricles at end of diastole

29
Q

Define Afterload

A

Resistance in left ventricle must overcome to circulate blood

30
Q

Functions of Angiotensin II?

A
  • Retention of Na+ by kidney (via aldosterone)
  • H2O retention by kidney (via Na+ uptake and vasopressin)
  • Salt appetite
  • Increased drinking (via Subfornical organ)
  • Increased BP
31
Q

What is the long-term regulation of Renin-Angiotensin-Aldosterone System (RAAS)?

A
  1. Fall in blood pressure
  2. Release of Renin
  3. Angiotensinogen
  4. Angiotensin I
  5. Angiotensin II
    • Two pathways
      1. Aldosterone > sodium retention > BP increase
      2. Vasocontriction > BP increase
32
Q

What are juxtaglomerular cells?

A
  • Specialised smooth muscle cells which act as mechanoreceptors which stretch in response to increase in BP of the afferent arteriole
    • also synthesise and secrete the enzyme renin which serves to activate the inactive precursor, angiotensinogen (made by the liver), into angiotensin I
33
Q

Two major functions of ATII

A
  • Vasoconstriction
  • Aldosterone Release

Fundamentals of Pharmacology (21 decks)

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