hypertension 3

Question 1

what are the two types of pharmacological therapy for hypertension?

Answer 1

1- Sympatholytic Agents

2- Directly-acting Vasodilators

Question 2

what are the two types of sympatholytic agents?

Answer 2

a-Adrenoceptor Blocking Drugs

Centrally-acting Drugs

Question 3

what are the 3 types of directly acting vasodilators?

Answer 3

Hydralazine
Minoxidil
Na nitroprusside

Question 4

what is the main A- adrenoceptor blocker and whats its MOA?

Answer 4

block a-1-adrenoceptors in arterioles & venules and decrease PVR

Question 5

what are the characteristics of the anti-hypertensive effect of A-adrenoceptor blockers?

Answer 5

fall in BP with associated -decrease TPR
little/no change in CO
orthostatic/postural hypotension

Question 6

benefits of A-adrenoceptor blockers?

Answer 6

favourable effects on plasma lipid & glucose levels
equal efficacy in all age & racial groups
most beneficial in patients with benign prostatic hypertrophy (BPH)

Question 7

what kind of therapy is A-adrenoceptor blocking drugs?

Answer 7

it is an add on therapy with BB and thiazide like diuretics- recommend for patients with resistant hypertension

Question 8

what are the adverse effects of a-adrenoceptor blocking drugs?

Answer 8

first-dose hypotension & syncope
postural hypotension
dizziness, fatigue, drowsiness, headaches
fluid retention & tolerance

Question 9

what are the 3 main centrally acting agents?

Answer 9

Clonidine
Moxonidine
a-Methyldopa

Question 10

what agonist is clonidine selective for clonidine?

Answer 10

a2- adrenoceptor agonist

Question 11

what is moxonidine selective for?

Answer 11

relatively selective a2-adrenoceptor & I1-imidazoline receptor agonist

Question 12

what is a-methyldopa selective for?

Answer 12

converted to a-methylnoradrenaline

a1-adrenoceptor agonist

Question 13

how do centrally acting agents produce their antihypertensive effect?

Answer 13

act centrally in lower brainstem/medullary vasomotor centre
a2-receptor activation -decrease sympathetic outflow to heart & blood vessels -decrease HR, CO & PVR -decrease BP
a2-receptor activation- increase cardiac vagal tone decrease HR and BP

Question 14

are the efffects of metabolism & plasma lipids favourable or unfavourable in centrally acting agents?

Answer 14

favourable

Question 15

what centrally acting agent is safe to use in pregnancy?

Answer 15

a-Methyldopa

Question 16

what are the 4 side effects of centrally acting agents?

Answer 16

1-sedation, drowsiness, mental lassitude, dry mouth
2-rebound effect
3-Na & fluid retention ->pseudotolerance
4- hypersensitivity reactions –drug fever, hepatitis, haemolytic anaemia

Question 17

what are the two oral directly acting vasodilators?

Answer 17

Hydralazine

Minoxidil

Question 18

what is the parental directly acting vasodilators ?

Answer 18

Na nitroprusside

Question 19

what directly acting vasodilator can be used for both oral and parenteral?

Answer 19

hydralazine

Question 20

how do directly acting vasodilators produce their effect?

Answer 20

relaxation of blood vessels/dilation

decrease in TPR and cO

Question 21

How does Na nitroprusside produce this antihypertensive effect?

Answer 21

increase intracellular cGMP - increase in relaxation

Question 22

how does relaxation Minoxidil produce its antihypertensive effect?

Answer 22

open K+channels > hyperpolarization

Question 23

what are the clinical uses for minoxidil and Hydralazine?

Answer 23

reserved for severe/refractory HPT

must be used in combination with diuretics & BBs

Question 24

what are the clinical uses for Na nitroprusside?

Answer 24

reserved for severe hypertensive crisis/emergencies

Question 25

what are the 3 adverse effects of directly acting vasodilators?

Answer 25

postural hypotension & fluid retention
reflex sympathetic stimulation- risk of angina
headaches, dizziness

Question 26

when do you treat adults with hypertension?

Answer 26

Adults of any age with persistent Stage 2 HPT (BP >160/100 mmHg)

Question 27

when do you treat adults under 80 with stage 1 hypertension?

Answer 27

when they also have one of the following:
target organ damage
existing / established CVD
renal disease
diabetes
an estimated 10-year CVD risk >10%

Question 28

when do you treat adults under 60 with stage one hpt?

Answer 28

when they have an estimated 10-year CVD risk <10%

Question 29

when do you treat adults over 80 for hpt?

Answer 29

a clinic blood pressure of over 150/90

Question 30

what are the clinical BP targets?

Answer 30

aim for target BP <140/90 mmHg in under 80 year olds

aim for target BP <150/90 mmHg in over 80 year olds

Question 31

what are the BP targets for BPM or HBPM in addition in patients with ‘white coat effect’

Answer 31

aim for target BP <135/85 mmHg in under80 year olds

aim for target BP <145/85 mmHg in over80 year olds

Question 32

what are the 3 types of drug therapy associated with hypertension treatment?

Answer 32

Initial Monotherapy with ‘Stepped-Care’ Approach
Initial Monotherapy with ‘Sequential Monotherapy’ Approach
Initial Combination Therapy (with SPC therapy)

Question 33

what is initial monotherapy with stepped care approach?

Answer 33

start with lowest recommended dose of 1st-line drug(s)
titrate up …. till BP control achieved, treatment not tolerated or maximum dose reached (except some diuretics)add next recommended drug …….
allow >4 weeks to observe full response at each

Question 34

what is combination therapy?

Answer 34

control of BP with two or more drugs

needed to achieve target BP levels in >60% of patients indicated for lower target BP levels & in high risk groups

Question 35

what is a disadvantage of combination therapy?

Answer 35

one drug may inhibit activation of compensatory mechanisms by another drug
e.g. b-blocker & diuretic with vasodilator
ACEI with diuretic
additive /synergistic effect achieved with drugs acting on different mechanisms
e.g. diuretic with b-blocker/ACEI/a-blocker