Hypertension

Question 1

Hypertension

Answer 1

Normal blood pressure = 120/80
Hypertension = 140/90
Hypotension = 90/60

Question 2

Primary and secondary hypertension

Answer 2

PRIMARY HYPERTENSION
- 90% of cases are unknown causes
- risk factors include genetics, ethnicity, diet, obesity, age, diabetes, stress, smoking, physical inactivity

SECONDARY HYPERTENSION
- secondary to a known primary problem - 10 % cases
- defective kidney blood supply/kidney damage
-chronically elevated peripheral resistance
- consequences of endocrine disorders
- secondary to neural lesions

Question 3

Hypertension complications

Answer 3

• left ventricle hypertrophy
• systolic heart failure
• stroke
• heart attack
• kidney failure
• progressive loss of vision
• atherosclerosis

Question 4

Non Pharmacological interventions of hypertension

Answer 4

• weight loss
• restrict salt intake
• regular exercise
• avoid smoking
• reduce stress

Question 5

Drug treatments of hypertension

Answer 5

• diuretics
• beta adrenergic receptor blockers
• calcium channel blockers
• RAAS inhibitors/blockers
• sympathetic nervous system modulators

Question 6

How do diuretics work ?

Answer 6

Diuretics work by increasing urinary output

Different types of diuretics :
- carbonic anhydrase inhibitors
- osmotic diuretics
- loop diuretics
- thiazides
- potassium sparing diuretics

Question 7

How do beta adrenergic receptor blockers work ?

Answer 7

They work by reducing cardiac output
- B1 adrenergic receptors are primarily found in the heart
- their activation increases the rate and strength of cardiac contraction
- HR, SV, CO all reduced

Question 8

How do calcium channel blockers work ?

Answer 8

decrease entry of ca2+ into vascular smooth muscles.
- increased vasodilation and decreased peripheral resistance
- calcium is needed for both cardiac and smooth muscle contraction

Question 9

How do RAAS inhibitors/blockers work ?

Answer 9

• angiotensin-converting enzyme ( ACE ) inhibitors = decrease angiotensin 2 production leading to increased vasodilation and decreased peripheral resistance. additionally it leads to decreased aldosterone and increased Na+ and water excretion
• angiotensin receptor blockers = decreased binding of angiotensin 2 to its receptors resulting in decreased peripheral resistance and decreased aldosterone
• Mineralocorticoid receptor antagonists = decreased binding of aldosterone to its receptors in the kidney leading to increased Na+ and water excretion

Direct renin inhibitors = inhibit production of angiotensin 1 so therefore decreased angiotensin 2

Question 10

How do sympathetic nervous system modulator work ?

Answer 10

• central alpha receptor agonists = decreased sympathetic signal by acting within the brain
• peripheral alpha receptor antagonists = relax the vascular smooth muscle and hence decreased peripheral resistance