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Drugs: from molecules to man > Hypertension 1 > Flashcards

Hypertension 1 Flashcards

1
Q

What does it mean that cardiac disorders exist as a complex web?

A

They often lead to each-other

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2
Q

What are determinants of cardiovascular disorders?

A
  • lifestyle

- genetics

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3
Q

how is blood pressure usually written?

A

systolic/diastolic

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4
Q

What is systolic blood pressure?

A

pressure while heart is contracting (maximum pressure)

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5
Q

What is diastolic blood pressure?

A

pressure while heart is filling (minimum pressure)

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6
Q

What is the pulse pressure?

A

Difference between systolic and diastolic pressure

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7
Q

What is hypotension and what could it be caused by?

A

decreased BP (could be caused by antihypertensive drugs acting too much)

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8
Q

What measurements do we use to quantify hypertension?

A

diastolic measurements

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9
Q

What are the different stages of hypertension?

A
  • Stage 1, mild hypertension – 90-100 mmHg
  • Stage 2, medium – 100-120 mm Hg
  • Stage 3 – severe - >120 mm Hg
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10
Q

What is white code hypertension?

A

when someone is nervous about getting a blood pressure measurement and it goes up just because of presence of doctor

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11
Q

How are ambulatory blood pressure measurements carried out?

A

patient carries around a belt mounted device connected to cuff on their arm through the entire day giving measurements of blood pressure

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12
Q

How many hypertensive patients are adequately controlled and how many are at optimal blood pressure?

A
  • 60% adequately controlled

- 10% at optimal blood pressure

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13
Q

Why is there an estimated 70 million untreated hypertensive patients in the world’s top 7 economies?

A

 Maybe inadequate access to healthcare

 Many people may not know they have hypertension – silent killer

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14
Q

What are primary and secondary hypertension?

A
  • Primary (essential or idiopathic) hypertension – cause unknown
  • Secondary hypertension – identified cause such as polycystic renal disease, renal artery stenosis and phaeochromocytoma (tumour of adrenal medulla – stimulates production of large quantity of adrenaline)
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15
Q

What may contribute to primary hypertension?

A 
- Lifestyle contributors 
 Obesity 
 Insulin resistance
 High alcohol intake 
 High sodium, low potassium intake 
 Age 
- Genetic factors 
 Up to 65% (twin studies) 
 Around 10 genes identified that alter salt/water balance 
 Other genes may affect obesity, alcohol use etc 
 Epigenetics: maternal diet
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16
Q

What are consequences of hypertension?

A
  • High sustained arterial BP increases mortality from:
     Coronary artery disease
     Stroke
     Cerebral haemorrhage
     Thrombosis (ischaemic) and thromboembolism
     Heart failure (heart reacts to sustained increase in blood pressure by remodelling it’s muscle and becoming less efficient
17
Q

What is the NICE care package for hypertension?

A
  • Stage 1 hypertension (unless age>80, or organ damage)
     Lifestyle interventions
     Education, support, and annual monitoring
     If under 40 get specialist referral
  • Stage 2 hypertension
     Offer antihypertensive therapy in addition to lifestyle interventions
18
Q

What are some lifestyle modifications that are suggested with hypertension?

A
  • lose weight
  • limit alcohol intake
  • increase aerobic activity
  • reduce sodium intake
  • maintain K+ intake
  • maintain Ca2+ and Mg2+ intake
  • Stop smoking
  • reduce dietary fat and cholesterol
19
Q

What are first line and second line treatments?

A
  • First line treatment: the drugs that are usually chosen as the initial treatment for a patient. If they don’t work then doctors will move on to second line treatments or may use adjunct treatments
  • Second line treatments: What is tried next. If it is in addition to the first line treatment, then it is described as adjunct or adjuvant treatment
20
Q

How do you work out blood pressure?

A

cardiac output x peripheral resistance

21
Q

What is the basic principle in blood pressure control by drugs?

A

interfere with control mechanisms. But do not compromise cardiovascular reflexes

22
Q

Are most patients taking one medication or more to treat hypertension?

A

More than one

23
Q

What happened with the ASCOT trial?

A

(Anglo Scandinavian Cardiac Outcomes Trial)
- Compared amlodipine (+ perindopril) newish with atenolol (+ Bendroflumethiazide) older treatments
- Amlodipine – calcium channel blocker
- Perindopril – angiotensin converting enzyme inhibitor
- Atenolol – beta adrenoceptor antagonist
- Bendroflumethiazide – diuretic
- Two arms
 1 arm – people were given amlodipine and supplemented with perindopril if needed additional help
 2 arm – people were given atenolol and supplemented with Bendroflumethiazide if needed additional help
- Results
1. Blood pressure reduced in both arms of study
2. Reduced incidence of associated CV disease with amlodipine
3. Conclusion: Calcium channel blocker (+ ACE inhibitors) should replace ‘older’ treatments

24
Q

Which trial underlies NICE recommendations?

A

ASCOT trial

25
Q

What happened with the ALLHAT trials?

A
  • Antihypertensive and Lipid-lowering treatment to prevent heart attack trial)
  • Compared chlorthalidone (thiazide-like diuretic) with amlodipine or lisinopril (another angiotensin converting inhibitor)
  • Results:
    1. Blood pressure controlled in all three but chlorthalidone superior
    2. Risk of heart attack similar with all three
    3. Risk of some associated CVS lower with chlorthalidone
    4. Conclusion: thiazide diuretic superior to calcium channel blockers or ACE inhibitors
26
Q

What trial underlies American Association recommendations?

A

ALLHAT trial

27
Q

What are the overall conclusions to do with the treatment of hypertension?

A
  • Calcium channel blockers or ACE inhibitor or ATII antagonist or thiazide-like diuretic should be primary treatment
  • May need to add in other drugs e.g. beta blocker

Drugs: from molecules to man (22 decks)

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