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Systemic Hypertension Flashcards

1
Q

Hypertension classification

A
  • Primary
    • 90%
    • aetiology unknown but has risk factors
      • risk factors are multifactorial involving genetics, smoking, stress, environment, diet
  • Secondary
    • 10%
    • high BP is secondary to an abnormality or drug
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2
Q

Symptoms of Hypertension

A

it has none, it is a silent killer

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3
Q

Hypertension is a risk factor for…

A

stroke, HF, CAD

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4
Q

Drugs commonly used to treat Hypertension and/or HF

A

ACEi/ARBS

B-Blockers

Ca+ channel blocker( not for HF)

Diuretics

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5
Q

T/F

ACE2 is also targetted by ACEi

A

False

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6
Q

Define

ACE2

A

converts AngII to Ang(1-7) whose effects are opposite to AngII(vasodilating and natriuretic)

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7
Q

Ang(1-7) may exert cardioprotective effect via the receptor…

A

Mas receptor

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8
Q

ACE2 in CVD prevalence in 2020

A

COVID19 internalises ACE2—> promotes AT1 mediated pathology–> increased CVD incidence after COVID19 infection

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9
Q

B-blocker mode of action

A

Decreases sympathetic drive to the heart —> results in lower CO, lower HR and lower TPR. Inhibits renin release as well–> decreased ang II as Kidneys symp innervated

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10
Q

Beta blockers are used to treat

A
  • Hypertension but not first line
  • angina
  • post-MI
  • Arrhythmias
  • clinically stable heart failure
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11
Q

B1 selective antagonists are

A

atenolol and metoprolol

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12
Q

Nonselective b1 and b2 antagonists are

A

propanolol

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13
Q

B-adrenoreceptors antagonists in HF

A

carvedilol and nebivolol found to reduce chronic stable heart failure and decrease mortality

potentially are antiarrhythmic, anti-ischemia and reduce NA toxicity as people with chronic HF tend to have higher NA and Adrenaline

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14
Q

Nonhydropyridine

A

more specific to the heart, decreased BP, decreased HR, decreased TPR

e.g verapamil and diltiazem

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15
Q

dihydropyridine

A

less cardiac specific, lower bP by alot, increase HR as a baroreceptor reflect and decrease TPR by a lot

nifedipine and alodipine

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16
Q

What does Ca+ channel blockers do

A

cause vasodilation, reduce cardiac contractility and reduce atrioventricular conduction

17
Q

order of most heart selective Ca+ channel blockers

A

verapamil>diltiazem>nifedipine

18
Q

Ca+ channel blockers are used to treat…

A

hypertension, angina, supraventricular tachyarrhythmias

19
Q

Verapamil is very good at

A
  • reducing cardiac contractility
  • reducing atrioventricular conduction
  • good for supraventricular tachyarrhythmias
20
Q

Should not use Ca+ channel blockers for…

A
  • Heart failure
  • verapamil or diltiazem when combined with B blocker
21
Q

adverse effects of Ca+ blockers

A
  • cardiac depression and bradycardia
  • flushing, edema, dizziness, headache
  • constipation, nausea
22
Q

Define

Diuretics

A

Inhibit Na+ reabsorption

23
Q

Mechanism of action of diuertics

A

increases Na+ excretion–> increases H2O excretion–> decreased BV, Venous pressure and Venous return

24
Q

long term vs short term effects of diuretics

A

short term: initially a lowering of CO

Long term: slightly lower CO than normal, reduced TPR

25
Q

3 major classes of diuretics

A
  1. Loop diuretics
  2. Thiazide diuretic
  3. Aldosterone receptor antagonists
26
Q

Loop diuertics

A
  • act on the thick ascending limb of the loop of henley to block Na+/K+2cl- symporter
  • blocks 15-25% of filtered sodium reabsorption
    • greatest diuretic efficacy
27
Q

Thiazide diuretic

A
  • acts on distal convoluted tubules to block na+/Cl- symporter
  • 5-10% of sodium excretion

e.g hydrochlorothiazide

28
Q

When treating mild to moderate hypertension with diuretics we would use…

29
Q

When treating edema due to congestive heart failure, pulmonary congestion or renal/liver disease with diuretics we would use…

A

Furosemide

30
Q

Adverse effects of loop diuretics and thiazides

A
  • Electrolyte imbalance
    • hypokalemia
      • can lead to arrhythymia
  • hyperuricemia(gout)
  • hypercholesterolemia
  • hyperglycemia
31
Q

Aldosterone receptor antagonist

A
  • also called K+ sparing diuretics in distal tubules or collecting ducts
  • inhibits mineralocorticoid receptor ( ald receptor in kidney)
  • in heart inhibits ald induced fibrosis and thus improves HF

e.g spironolactone

32
Q

Spironolactone clinical uses

A
  • used in combo with thiazides and loop diuretics to produce a weak diuresis eihtout hypokalemia
  • used in conditions associated with hyperlaldosteronism
  • improves survival thus resurgence of interest in chf
  • resitant hypertenison add on therapy maybe
33
Q

Adverse effects of spironolactone

A

hyperkalemia

34
Q

new targets fro hypertnesion

A

inflammation, fibrosis, RAS, AT2

BM3052 (25 decks)

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