Hypertension and heart failure Flashcards
what is the equation for BP?
COTPR or HRSV*TPR
How does diabetes cause high blood pressure ?
endothelial dysfunction and increase in ROS = Medial hypertrophy of vessels
what is Nice definition of stage 1 hypertension ?
stage 2 ?
severe ?
BP higher than 140/90 ABP = 135/85 stage 2 = 160/100 ABP = 150/95 severe = 180 / 110
What is the primary cause of hypertension ?
Idiopathic (Essential)
how do you take a BP ?
patient is sat down relaxed and arm supported
repeat on both arms if >20 difference repeat on higher arm
What is prehypertensions and how is it normally treated ?
elevated BP below stage 1 with no end organ damage.
Lifesyle changes
What are the 3 main types of anti-HT agents ?
ACE inhibitors /Ang Receptors (ARBs)
Calcium Channel blockers
Diuretics
where is ACE found ? where does ANG 2 work on ?
Luminal surface of capillary endothelial cells in the lungs
AT1 and AT2
What receptor is most potent for ANG2 and what are the effects?
AT1,
Vasoconstriction , Aldosterone release, ADH release and vascular muscle cell growth
Name 2 Ace inhibitors
Captopril, Ramipril , Enalapril and lasinopril
Why are ARBs used sometimes of ACE-i ?
ANG 2
what are the main side effects of ACE-i?
dry cough (BK build up), Angioedema , renal failure and Hyperkalaemia
What are the effects of Bradykinin on the body ?
Dry cough and vasodilation via NO and PGI2
what are the side effects of ARBs and what do they target ?
Renal failure and hyperkalaemia , no BK = no dry cough
AT1 receptors
what are the ways ANG2 is made ?
RAAS system
Chymase production
name 2 ARBs
Iosartan
Candesartan
eprosartan
irbesartan
what class of CCBs target VSMCs?
Dihydropyridines
What class of CCBs target Cardiac myocytes ?
Phenylalkyamines and benzothazapines , non dihydropyridines
what class of CCBs sits in the middle ?
benzothiazapines
When would you use CCBs over ACE-i in first line treatment ?
low renin hypertensives
name 2 dihyropryridines
Amlodipine , nifedipine and nicardipine
what are properties of Dihydropyridines ?
Good oral absorption
protein bound
metabolised by liver
what are the side effects of dihyropyridines ?
Tachycardia - sympathetic activation palpitations Flushing, sweating , headaches oedema reaction with simvastatins
what is the MOA of Phenylalkylamines ? what is the overall effect?
impeded calcium transport across myocardial membrane
prolongs the AP and refractory period
negative chronotrophic and inotropic
Used in angina and arrthymia
side effects of phenylalkylamines
bradycarida , constipation and worsen HF
name a phenylalklamine
verapamil
Name a benzothiazapine ? what is a good for ?
diltiazem and angina
why do afro-carbianen or >55 a years old patients go straight to CCBs or Diuretics?
low renin activity
what is the MOA of Thiazides ?
Inhibit Na+ reabsorption in DCT
What are the side effects of thiazides ?
Hypokalaemia , increased Urea levels, glucose intolerence , hyperlipidemia, activates RAAS
Name 1 thiazide
bendroflumethiazide
indapamide
what can be used in hypertensive emergencies ?
Nitriates e.g. SNP
Labetalol - beta blocker, Good in pregnancy
name a A1 Blocker and its side effects
doxazosin
postural hypotension
headache and fatigue
oedema
name a beta blocker and its side effects
bisoprolol
bronchoconstriction
mask tacycardia
Raynaud’s - cold hands
what are the main causes of acute HF ?
Haemorrhagic shock, cariogenic shock (MI) or septic shock
what do we mean by self perpetuating cycle of HF?
Decresed CO leads to more vasoconstriction via RAAS lead to increased afterload and preload = worsening HF
What is the management of HF?
Diuretics- treat symptoms , treat underlying condition
ACEi and beta blockers . similar to HT.
what is digoxin used for ?
an adjunct therapy of HF - only patients with Sinus rhythm
used in AF
What is ivabradine ?
If current blocker = slows HR
What is sacubitril ?
potentiates ANP and BNP = Loss in BP
