Hypertension Flashcards
Who tends to develop hypertension earlier?
Blacks and men. That being said, women develop disease sooner after onset.
How does renal artery stenosis cause hypertension?
The tubules are underperfused and secrete more renin, leading to more sodium and water reabsorption.
How do NSAIDs cause hypertension?
They block prostaglandins and prostacyclins, which results in increased blood pressure.
The risk of end organ disease is higher in what two groups?
Black people and pre-menopausal women.
What drug groups increase plasma volume?
Sympatholytics, beta blockers, arteriolar vasodilators, calcium channel blockers
What drug groups decrease plasma volume?
ACEIs and ARBs.
What group of diuretics are the most used?
Thiazide diuretics.
When do you switch from thiazides to loop diuretics?
When the GFR gets too low. The thiazides won’t work then.
When do you use loop diuretics in general?
Severe HTN in the setting of CHF, Cirrhosis or with Renal Insufficiency.
What are some side effects of loop and thiazide diuretics?
- Hypokalemia
- Hypomagnesemia
- Impaired glucose tolerance
- Hyperlipidemia
- Hyperuricemia (watch out for gout)
- Erectile dysfunction
- Volume dysfunction (avoid taking if you are vomiting or have diarrhea).
What is the most potent thiazide?
Metolazone
Why are ACEIs so good for treating hypertension?
Not only do they block the production of Angiotensin II, but some of the leftover angiotensin I gets converted to bradykinin, which is a potent vasodilator.
What is the shortest acting ACEI?
Captopril
Which ACEI is converted to a more active metabolite?
Enalapril (converts to enalaprilat)
What are ACEIs and ARBs contraindicated in?
Renal artery stenosis (by inhibiting aldosterone, you inhibit their compensatory mechanism, leading to dehydration), hyperkalemia, renal failure, pregnancy (birth defects)
