Hypertension Flashcards

1
Q

What is hypertension?

A

Hypertension is defined as 140/90 mmHg

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2
Q

What is primary and secondary hypertension?

A
  • Primary hypertension is without single evident cause

- Secondary hypertension is high blood pressure with a discrete identifiable underlying cause and it is less common

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3
Q

What is the 1st line treatment for hypertension?

A
  • ACE inhibitors
  • Calcium Channel Blockers
  • Diuretics
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4
Q

What are some example of ACE inhibitors?

A
  • Lisinopril

- Ramipril

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5
Q

What is the mechanism of action demonstrated by ACE inhibitors?

A
  • Inhibition of Angiotensin Converting Enzyme activity

- Prevents generation of Angiotensin 2

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6
Q

What are the effects of ACE inhibitors?

A
  • Some venodilation
  • Mainly vasodilation
  • Circulating aldosterone is reduced
  • Potentiates the action of bradykinin

This cause lowering of Blood Pressure

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7
Q

What are the indications of ACE inhibitors?

A
  • Heart Failure
  • LV dysfunction
  • Myocardial infarction
  • Diabetes
  • Nephropathy
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8
Q

What are the side effects of ACE-inhibtors?

A
  • Dry Cough
  • Angio-oedema
  • Renal failure
  • Hyperkalaemia
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9
Q

What are some contraindications of ACE inhibitors?

A
  • Pregnancy
  • Renovascular Hypertension
  • Renal impairment
  • Pulmonary vascular disease
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10
Q

What are some examples of angiotensin receptor blockers?

A
  • Losartan

- Candesartan

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11
Q

What is the mechanism of action demonstrated by angiotensin receptor blockers?

A

Binds to angiotensin AT1 receptor

  • Inhibits Vasoconstriction
  • Inhibits aldosterone stimulation caused by angiotensin 2

This leads to blood pressure lowering

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12
Q

When are angiotensin receptor blockers used?

A
  • ACE inhibitor intolerance
  • Hypertension with LVH
  • Type 2 Diabetes Mellitus
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13
Q

What are the side effects of angiotensin receptor blockers?

A
  • Renal failure

- Hyperkalaemia

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14
Q

What are some contraindications of angiotensin receptor blockers?

A
  • Pregnancy
  • Renovascular hypertension
  • Renal impairment
  • Pulmonary vascular disease
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15
Q

What are the types of calcium channel blockers?

A
  • Dihydropyridines
  • Phenylalkylamines
  • Benzothiazepines
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16
Q

What are some examples of Dihydropyridines?

A
  • Amlodipine

- Nifedipine

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17
Q

What are the effects of Calcium Channel Blockers?

A
  • Vasodilates peripheral, coronary and pulmonary arteries

- No significant effect on veins

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18
Q

What are the properties of Dihydropyridines?

A
  • Good oral absorption
  • Protein bound >90%
  • Metabolised by the liver
  • Few have active metabolite
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19
Q

What are some uses of Dihydropyridines?

A
  • Blood pressure lowering
  • Short acting dihydropyridines affect the baroreceptor mediated tachycardia
  • Used in the elderly and ISH
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20
Q

What are some side effects of Dihydropyridines?

A
  • Oedema commonest
  • Sympathetic nervous system activation leading to tachycardia and palpitations
  • Flushing, sweating, throbbing headache
  • Gingival hyperplasia
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21
Q

What are the properties of Phenylalkylamines?

A
  • Impedes calcium transport across the myocardial and vascular smooth muscle cell membrane
  • Class 4 anti-arrhythmic agent/prolongs the action potential/effective refractory period
  • Peripheral vasodilation and a reduction in cardiac preload and myocardial contractility
22
Q

What are some properties of Benzothiazepines?

A
  • Impedes calcium transport across the myocardial and vascular smooth muscle cell membrane
  • Prolongs the action potential/effective refractory period
  • Peripheral vasodilation and a reduction in cardiac preload and myocardial contractility
23
Q

What are the uses of Phenylalkylamines?

A
  • Blood pressure lowering
  • Verapimil depresses the SA nodes and slows AV conduction
  • Used in Angina
24
Q

What are the main side effects of Phenylalkylamines?

A
  • Constipation
  • Risk of bradycardia
  • Reduce myocardial contractility (negative inotrope) - Worsen heart failure
25
What are the contraindications of Phenylalkylamines?
- Heart block - Heart failure - Careful with combination with beta-blockade
26
What the uses of Benzothiazepines?
Bood pressure lowering
27
What are the side effects of Benzothiazepines?
- Risk of bradycardia | - Less negative ionotropic effect than verapamil - can worsen heart failure
28
What are some examples of Thiazide/Thiazide Like diuretics?
- Bendroflumethiazide | - Indapamide
29
What are some effects of thiazide/thiazide like diuretics?
- Reduce distal tubular sodium reabsorption - Sustained action - Blood pressure reduction complex. Has some vasodilator properties as well as venodilation - Dose-blood pressure response curve: flat
30
What are some uses of thiazide/thiazide like diuretics?
- Blood pressure reduction by several mechanisms by initial blood volume decrease and later total peripheral resistance falls - Used in elderly patients, heart failure patients and ISH
31
What some side effects of thiazide/thiazide like diuretics?
- Hypokalaemia - Increased urea and uric acid levels - Impaired glucose tolerance (especially with beta-blockers) - Cholesterol and triglyceride levels increased - Activates RAAS
32
What are some contraindications of Thiazide/Thiazide like diuretics?
-Gout
33
What are some examples of alpha blockers?
Doxazosin
34
What are some effects of alpha blockers?
- Selective antagonism at post-synaptic alpha 1 adrenoceptors and antagonise the contractile effects of noradrenaline on vascular smooth muscle - Reduce peripheral vascular resistance - More effect in upright position - Benign effect on plasma lipids/glucose - Safe in renal disease
35
What are the uses of Alpha blockers?
Blood pressure reduction
36
What are the side effects of alpha blockers?
- Postural hypotension and dizziness - Headache and fatigue - Oedema
37
What the contraindications of alpha blockers?
- Urinary Incontinence - Postural hypotension - Heart Failure
38
What are some examples of Beta Blockers?
- Atenolol - Bisoprolol - Nebivol - Propanolol - Esmolol
39
What are the physiological effects of Beta Blockers in heart failure?
1. Reduce heart rate - Cardiac beta receptor 2. Reduce blood pressure - Reduce cardiac output. The combination of 1+2 leads to reduced myocardial oxygen demand 3. Reduce mobilisation of glycogen 4. Negative unwanted effects of catecholamines
40
What are the effects of Beta Blockers?
- Reduce heart rate and cardiac output - Inhibit renin release - Initially TPR increases later falls to normal
41
What are uses of Beta Blockers?
- Blood pressure reduction | - Used in MI/Angina
42
What are the side effects of beta blockers?
- Lethargy impaired concentration - Reduced exercise tolerance - Bradycardia - Cold hands - Raynaud's - Impaired glucose tolerance
43
What are the contra-indications of Beta blockers?
- Asthma - Heart block - Heart failure - PVD (caution) - Diabetes except with CHD
44
What is the mechanism of action demonstrated by Aliskeren?
- Direct renin inhibition by suppression at the point of activation - Reduces plasma renin activity by 50% - 80% - Blood pressure reduction by vasodilation
45
What are the types of Centrally acting agents and how do they work?
Reduce sympathetic outflow - Methydopa: converted to alpha methyl noradrenaline - a potent alpha-2 adrenoceptor agonist - Clonidine: Direct pre-synaptic alpha 2 adrenoceptor agonist - Moxonidine: imidozoline receptor agonist and some alpha 2 agonist effect
46
What are the uses of centrally acting agents?
-Used in hypertension however less commonly
47
What are the side effects of centrally acting agents?
- Tiredness/lethargy | - Depression
48
How are combination therapies used effectively in hypertension?
- Hydrochlorthiazide: Thiazide diuretic which lowers BP and raises glucose as well as lowering K+ - Amiloride: K+ sparing diuretic which lowers BP and has no effect on glucose Combination of the 2 at half dose result in greater decrease in BP with no effect on K+ and glucose
49
What are the principles of managing heart failure?
Correct underlying cause Non-pharmacological measures Pharmacological therapy - Symptomatic improvement - Delay progression of heart failure - Reduce mortality Treat complications/associated conditions/cardiovascular risk factors
50
How are beta blockers administered in heart failure?
- Care need to be taken. Failing myocardium dependant on heart rate - Initiate at low dose and titrate slower. May have to alter concomitant medication such as diuretics
51
What are examples of Phenylalkylamines?
Verapamil
52
What are examples of Benzodiazepines?
Diltiazem