Hypertension

Question 1

What regulates BP?

What does it regulate?

Answer 1

Renin-angiotensin system.

It regulates sodium conc in arterial blood.

Question 2

Explain the renin-angiotensin system

Answer 2

Decreases in BP, blood vol or plasma Na+ causes:
> increases in renin
> renin convertes angiotensinogen to angiotensin I
>ACE (angiotensin converting enzyme) converts angiotensin to angiotensin II
>angiotensin II causes vasoconstriction and increase in aldosterone.
(increase in aldosterone increases reabsorption of sodium and excretion of potassium).
> BP increases

Question 3

What BP is considered pathological:

Answer 3

If systolic or diastolic: >140/90mmHg.

Question 4

What are the signs of hypertension?

Answer 4

No outward signs - often silent disease until something devastating happens.

Question 5

Name the different stages of hypertension

Answer 5

Optimal: <120/<80
Normal: <130/<85
High normal: 130-139/85-90
Stage I hypertension: 140-159/90-99
Stage II hypertension: 160-179/100-109
Stage III hypertension: >180/>110

Question 6

Name the diagnostic test for hypertension

Answer 6

Sphygmomanometer - measure BP

Also look for secondary effects: ECG, renal function, eyes, Ix (examination) for secondary causes)

Question 7

What are the risk factors of hypertension/

Answer 7

• Family history
• Afro-Caribbean
• Obese
• Diabetes
• Alcohol
• Smoking
• Sedentary lifestyle

Question 8

How do you manage HP:

Answer 8

lifestyle changes, weight, smoking, EtOH (ethanol - alcohol), exercise, diet.

Persistent BP > 160/90 = DRUGS
AB/CD = Angiotension, Beta/Calcium, Diuretic

Question 9

When do you use drugs to treat hypertension?

Answer 9

When the BP is above 160/90

Question 10

What does AB/CD stand for?

Answer 10

Angiotension, Beta/Calcium, Diuretic

young: <55, old >55 yrs old
young: A or B > C or D > A or B AND C or D
old: C or D > A or B > A or B AND C or D

Question 11

Name the drugs used to treat hypertension

Answer 11

Beta-blockers (B1 & B2) e.g. propanolol
Calcium channel blockers e.g. amlodipine
Angiotensin Converting Enzyme (ACE) inhibitors e.g. lisinopril
Angiotensin II receptor blockers e.g. losartan
Thiazide diuretic e.g. metolazone
Potassium sparing diuretics e.g. spironolactone
a1 blockers e.g. doxazosin
a2 agonists e.g. methyldopa

Question 12

What is the mechanism of action for Beta Blockers e.g. propranolol

Answer 12

Decrease HR, CO.

Relax SM

Question 13

What is the mechanism of action for calcium channel blockers e.g. amlodipine?

Answer 13

Vascular smooth muscle relaxation

Question 14

Angiotensin converting enzyme (ACE) inhibitors e.g. lisinopril

Answer 14

inhibit conversion of angiotensin I to angiotensin II

Question 15

angiotensin II receptor blockers e.g. losartan

Answer 15

blockade of angiotensin II receptors

Question 16

Loop diuretics e.g. furosemide

Answer 16

Decrease Na, K and Cl absorption in loop of Henle

Question 17

What do Thiazide diuretics e.g. metolazone do?

Answer 17

Decrease Na absorption in the distal tubule

Question 18

Potassium sparing diuretics e.g. spironolactone

Answer 18

Decrease Na absorption in the collecting duct

Question 19

What are the oral manifestations of antihypertensive drugs?

Answer 19

• Xerostomia
• Gingival hyperplasia
• Lichenoid reactions
• Cough and loss/alteration of taste (ageusia/dysgeusia)

Question 20

Do antihypertensive drugs have drug interactions with LA and analgesics?

Answer 20

Yes

Question 21

What can a persistently high BP cause:

Answer 21

stroke, heart disease, renal disease, visual failure, …death.

Question 22

What is the most common cause of hypertension?

Answer 22

Essential hypertension

Question 23

A 49yr old white male patient presents with blood pressure 168/95mmHg. He is otherwise fit and well. What is the preferred first-line drug class for management of his hypertension?

Answer 23

ACE inhibitors

Question 24

Which antihypertensive meds are linked with the development of gingival hyperplasia?

Answer 24

Calcium channel blockers