Hypertension treatment Flashcards
What is blood pressure?
→ Pressure exerted by blood on blood vessels
What does short term regulation of blood pressure involve?
→ baroreceptors
→ Sympathetic and parasympathetic outflow
What does long term regulation of blood pressure involve?
→ Hormonal control of total body Na+
→ Control of blood volume via ECFV
→ Degree of vasoconstriction
What is the criteria for hypertension?
→ 140/90 mmHg
What is hypertension a risk factor for?
→ Stroke → Ischaemic heart disease → Left ventricular hypertrophy and heart failure → renal failure → retinopathy
What are secondary causes of hypertension?
→ Renal
→ Vascular - renal artery stenosis
→ Hormonal - Conns, Cushings
→ Monogenic genetic diseases - Liddles
What is a primary cause of hypertension?
→ Genetic pre disposition and environmental factors
What are 3 possible mechanisms for essential hypertension?
→ Increased sympathetic nervous system
→ Increased RAAS
→ endothelial dysfunction
What are 2 possible defects in essential hypertension?
→ Vascular smooth muscle contraction
→ Na+ handling and excessive salt intake
What are 4 risk factors for essential hypertension?
→ Obesity
→ Age
→ Ethnicity
→ Family history
What does the treatment of hypertension reduce the risk of and by how much?
→ Strokes by 42%
→ Heart attacks by 16%
→ Vascular mortality by 21%
What are the goals of anti-hypertensive treatment?
→ Adequate blood pressure control
→ Prevention of target organ damage
→ Controlling other cardiovascular risk factors
What are the treatment pathways for hypertension?
→ Non-pharmacological
→ Pharmacological treatment
→ Surgical
What are 6 lifestyle changes to prevent hypertension?
→ Quit smoking → Weight control → Eating less salt → Regular exercise → Reduce alcohol intake → Behavioral therapy
What are 5 major classes of anti hypertensive drugs?
→ ACE inhibitors → Angiotensin II receptor blockers → Diuretics → Drugs acting on sympathetic nervous system → Vasodilators
What are 3 side effects from ACE inhibitors?
→ Cough - due to decrease in bradykinin breakdown
→ Angioedema
→ Hyperkalaemia
What do diuretics do?
→ Increase in Na+ and water excretion
→ Reduce blood volume
→ reduce BP and CO
Why do ACE inhibitors causes hyperkalaemia?
→ Reduced aldosterone
→ Decreased Na+ reabsorption
→ Decreased K+ excretion
What do Beta 1 receptors do?
→ Increase HR and contractilityn
→ Increase CO
→ Increase BP
What do alpha 1 receptors do?
→ vasoconstriction
→ TPR
→ Increased BP
What do beta blockers cause?
→ Reduction in CO and renin release
How do K+ channel openers work?
→ K+ channels open → K+ efflux → Hyperpolarization → Reduced VGCC activity → Reduced intracellular Ca2+ → Less MLCK activity + increased relaxation
How do Ca2+ channel blockers work?
→ Block VGCC activity in smooth muscle cells
→ reduced intra cellular Ca2+
→ Less MLCK activity + increased relaxation
What are issues to take into consideration when treating hypertension?
→ Evidence of efficacy → Side effects → Drug interactions → Quality of life → economic considerations
