Hypertension 2 Flashcards
Role of angiotensin II in organ damage
slide 91
State the contraindictions of ACE-i ( eg ramipril)
- renal artery stenosis
- renal failure
- hyperkalaemia
ADRs of ACE-i
- cough
- first dose hypotension
- tase disturbance
- renal impairment
- angioneurotic oedema
Drug-drug interactions of ACE-i
- NSAIDS ( precipitate acute renal failure)
- Potassium supplements (hyperkalaemia)
- Potassium sparing diuretics(hyperkalaemia)
State angiotensin II antagonists(ARB)
- Losartan, volsartan, candesartan, irbesartan
- Angiotensin II antagonists block actions of angiotensin II at angiotensin AT1 receptor
- no cough
State CCBs
-amlodipine/felodipine(vasodilator), verapamil/diltiazem ( rate limiting)
Mechanism of CCBs
- blocks L type calcium channels
- selectively between vascular and cardiac L type channels
- relaxing large and small arteries and reducing peripheral resistance
- reducing CO
When are CCBs offered?
- antihypertensive choice for >55yrs or women of child baring age.
- high compliance
- benefit in elderly patient with systolic hypertension
Contraindictions of CCBs
- acute MI
- HF, bradycardia ( rate limiting CCBs)
ADRs of CCBs
- flushing
- headache
- ankle oedema
- indigestion + reflux oesophagitis
Rate limiting agents also causes
- bradycardia
- constipation
State thiazide-type diuretics
-indapamide, chlortalidone
Mechanism of thiazide-type diuretics + ARDs
- Urinary excretion of Na+
- uncommon ARDs ( gout and impotence)
Less commonly used agents
Alpha-adrenoceptor antagonists
-Doxazosin
Centrally acting agents
- Methyldopa
- Moxonidine (imidazoline agonist)
Vasodilators
- Hydralazine
- Minoxidil
Alpha-adrenoceptor antagonists mechanisms and ADRs
Doxazosin
- selrvyibely block post synaptic alpha1-adrenoceptors
- oppose SM contraction in arteries
ADRs
- first dose hypotension
- dizziness
- dry mouth
- headache
Centrally acting agents mechanism and ADRs
Methyldopa
- used in hypertension of pregnancy
- converrted to alpha-methynoradrenaline which acts on CNS alpha-adrenoreceptors which decreases entral sympathetic outflow
ADRs
- sedation and drowsiness
- dry mouth/nasal congestion
- orthostatic hypotension
Treatment regimes
slide 105
Hypertension and pregnancy
- if during, at more risk of developing preeclampsia
- maternal and fetal death possible
- During NORMAL pregnancy, BP falls.Sometimes develops hypertension during pregnancy ( gestational hypertension)
- can be severe from 20wks BP 140/90mmHg and proteinuria > 300mg/24hr = preclampsia
Treatment of pregnancy hypertension
Prepregnancy;
-nifedipine MR, methyldopa, atenolol, labetalol
During pregnancy
-add thiazide diuretic and/amlodipine
Preeclampsia
-as above + IV hydralazine, esmolol,labetalol
Symptoms of untreated hypertension
Vascular
- aortic dissection
- anuerysm
- peripheral vascular disease
Brain
- stroke
- haemorrhages
Eyes
- papilloedema and retinal haemorrhage ( in malignant hypertension)
- blindness
Kidneys
- kidney failure
- proteinaemia
- uraemia
Heart
- Heart failure (congestive) – breathlessness, fatigue and (ankle) oedema
- Pulmonary oedema – dyspnoea, orthopnoea, haemoptysis, sweating
- MI – (radiating) chest pain, dyspnoea, sweating, feverish
- LVH – dyspnoea, chest pain, palpitations
