Hypertension Flashcards
Define hypertension.
Persistently elevated BP measured on 3 separate occasions, minimum of 2 days apart, systolic ≥140 and / or diastolic ≥90 mmHg
OR
When severely elevated, minimum of 3 readings on same visit.
>180mmHg/110mmHg
Outline the 3 causes of hypertension
Inappropriately high sympathetic outflow.
Inappropriately high renin release
abnormal renal salt/water handling
Which antihypertensive medication is more effective in a black population?
A calcium channel blocker + either thiazide or ACE inhibitor
What are the therapeutic objectives for the management of hypertension?
Reduce morbidity and mortality
Obtain target BP goals of <140/90 mmHg or <130/80 mmHg with diabetes or renal disease.
Prevent disease progression
Improve quality of life
On which part of the nephron does Loop diuretics work, give the receptor as well?
Thick ascending Loop of Henle
Na/K/2Cl
Which part of the nephron does thiazides work? Provide the receptor as well.
Early Distal convoluted tubule
NaCl symporter
Which part of the nephrone does aldosterone antagonist work? Provide the receptor as well.
Collecting Ducts
ENaC
Example of high ceiling diuretics.
Furosemide. Loop diuretics
Example of a Low ceiling diuretic
Thiazide diuretics. Hydrochlorothiazide.
Adverse side effects of Thiazides
Hypokalaemia
Hyponatraemia
Gout
Metabolic alkalosis
Glucose intolerance
What is hypo/hyperkalaemia an increased risk for?
Ventricular arrhythmias
How does the Thiazide lead to glucose intolerance
hypokaelemia, beta pancreatic cell hyperpolarization deceased insulin secretion.
Adverse effects of Loop Diuretics.
Hyponatraemia
Hypokalaemia
Hypocalcaemia
Postural Hypotension
Dyslipidaemia
Metabolic Alkalosis
Hearing impairement
Adverse effects of spironolactone,
Hyperkalemia
Oestrogen related effects
Erectile dysfunction
Which Diuretic is safe to use in a kidney failure?
Loop Diuretics
Adverse effects of ACE inhibitors.
Dry cough
Hyperkalaemia
Angioedema
First dose hypotension
Benefits of ACE-inhibitors
Reduce progression to diabetic glomerulopathy
reduce Glomerulosclerosis
Reduce ANG II and thus eliminates the unnecessary cardiac remodeling that happens after an MI
Contraindication for ACE inhibitors
Bilateral renal artery stenosis
Pregnancy
Previous History of angiodema
The function of Dihyropyridine.
Anti-hyertensives, ends in the pine
Vasodilation
Afterload reduction
SNS activation (transient reflex tachycardia)
Can be used with beta blockers.
The function of Non-dihydropyridine
Anti-arrythmic properties
Slow conduction in the SA and AV nodes
Depress sinus node
Cumulative negative ionotropic effect when used with β-blocker, should not be used with beta blockers
Mechanism of action of Calcium channel blockers.
Blocks voltage gated Ca2+ channels (L-type/slow channels)
this inhibits the uptake of Ca2+ into the cells and as a result no contraction can occur
Adverse effects of Calcium channel blockers.
Ankle oedema
Headache
Flushing
Constipation
Gum hypertrophy
Contraindications to calcium channel blockers.
Hypotension
Bradycardia
Decompensated Congestive Heart Failure
Contraindications for Non-dihropyridines.
Beta blockers
Pre-existing AV nodal disease
