hypertension

Question 1

stats of hypertension

Answer 1

• Normal blood pressure at rest: 100-140mmHg systolic and 60-90mmHg diastolic
• Hypertension: persistently at or above 140/90 mmHg
• Hypertension in diabetes: persistently at or above 140/80 mmHg

Question 2

what’s the difference between between primary and secondary hypertension

-no cause
- cause

Answer 2

• Primary hypertension (essential): 90%; no obvious underlying cause
• Secondary hypertension: 10% caused by known condition that is affecting the kidneys, arteries, heart, or endocrine system

Question 3

what are the causes of primary hypertension

Answer 3

o Age (increases with age)
o Family history
o Origin: African or Caribbean
o High salt diet
o Lack of exercise
o Smoking
o Alcohol
o Stress

Question 4

what are the causes of secondary hypertension

Answer 4

o Kidney disease
o Diabetes
o Narrowing of arteries - kidney
o Cushing’s syndrome (excess of steroid hormones)
o Oral contraceptive pill
o NSAIDs
o Recreational drugs
o Herbal supplements

Question 5

what are the treatment p,and for hypertension

Answer 5

o Aged under 55 years
 Step 1: ACE inhibitor or angiote receptor blocker (ARB)
 Step 2: ACE inhibitor or ARB + Calcium-channel blocker (CCB)
o Aged over 55 years or black person of African or Caribbean family origin of any age
 Step 1: ACE inhibitor or ARB
 Step 2: ACE inhibitor or ARB + CCB
 Step 3: ACE inhibitor or ARB + CCB + Thiazide-like diuretic

Question 6

what is the mechanism of action for ace inhibitors

-at1
-bk
- side effect

Answer 6

o Inhibition of ACE results in decreased AT1 receptor stimulation
o ACE inhibitors increase bradykinin (BK) levels by inhibiting its degradation
o Elevation of BK leads to cough as a side effect

o Enalapril, lisinopril, ramipril (oral once daily)- first line treatment

Question 7

mechanism of action for arbs

Answer 7

o Angiotensin II receptor blockade

• ARBs are given to patients who develop cough with ACE inhibitors; fewer side effects due to lack of effect on bradykinin
• Examples of ARBs: Losartan, valsartan, candesartan
• Side effects: usually well tolerated, potential link with MI and cancer being investigated

Question 8

when do you use cominnined ace inhibitors/ arb therapy

Answer 8

• Concerns about the adequacy of blockade of the renin angiotensin system when using only an ACE inhibitor or an ARB alone
• Combined ACE inhibitor/ARB therapy may be appropriate

Question 9

mechanism of action of calcium channel blockers

Answer 9

o Block calcium flux into cells
o Vascular smooth muscle vasodilation
o Decreased myocardial force generation (negative inotropy)
o Decreased heart rate (negative chronotropy)
o Decreased conduction velocity within the heart (negative dromotropy), particularly at the atrioventricular node

Question 10

other drugs that can be used for hypertension

Answer 10

• beta blockers - o Most β-blockers increase plasma triglycerides and decrease HDL- thus potentially atherogenic
• • α1-antagonists -

• Thiazide diuretics- o Reduce the risk of death, stroke, myocardial infarction, heart failure due to hypertension

• SNP: vasodilator- o SNP can be given intravenously in severe hypertension, and severe congestive heart failure; very rapid effects