Systemic Hypertension

Question 1

Hypertension classification

Answer 1

• 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

Question 2

Symptoms of Hypertension

Answer 2

it has none, it is a silent killer

Question 3

Hypertension is a risk factor for…

Answer 3

stroke, HF, CAD

Question 4

Drugs commonly used to treat Hypertension and/or HF

Answer 4

ACEi/ARBS

B-Blockers

Ca+ channel blocker( not for HF)

Diuretics

Question 5

T/F

ACE2 is also targetted by ACEi

Answer 5

False

Question 6

Define

ACE2

Answer 6

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

Question 7

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

Answer 7

Mas receptor

Question 8

ACE2 in CVD prevalence in 2020

Answer 8

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

Question 9

B-blocker mode of action

Answer 9

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

Question 10

Beta blockers are used to treat

Answer 10

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

Question 11

B1 selective antagonists are

Answer 11

atenolol and metoprolol

Question 12

Nonselective b1 and b2 antagonists are

Answer 12

propanolol

Question 13

B-adrenoreceptors antagonists in HF

Answer 13

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

Question 14

Nonhydropyridine

Answer 14

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

e.g verapamil and diltiazem

Question 15

dihydropyridine

Answer 15

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

nifedipine and alodipine

Question 16

What does Ca+ channel blockers do

Answer 16

cause vasodilation, reduce cardiac contractility and reduce atrioventricular conduction

Question 17

order of most heart selective Ca+ channel blockers

Answer 17

verapamil>diltiazem>nifedipine

Question 18

Ca+ channel blockers are used to treat…

Answer 18

hypertension, angina, supraventricular tachyarrhythmias

Question 19

Verapamil is very good at

Answer 19

• reducing cardiac contractility
• reducing atrioventricular conduction
• good for supraventricular tachyarrhythmias

Question 20

Should not use Ca+ channel blockers for…

Answer 20

• Heart failure
• verapamil or diltiazem when combined with B blocker

Question 21

adverse effects of Ca+ blockers

Answer 21

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

Question 22

Define

Diuretics

Answer 22

Inhibit Na+ reabsorption

Question 23

Mechanism of action of diuertics

Answer 23

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

Question 24

long term vs short term effects of diuretics

Answer 24

short term: initially a lowering of CO

Long term: slightly lower CO than normal, reduced TPR

Question 25

3 major classes of diuretics

Answer 25

1. Loop diuretics 2. Thiazide diuretic 3. Aldosterone receptor antagonists

Question 26

Loop diuertics

Answer 26

* 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

Question 27

Thiazide diuretic

Answer 27

* acts on distal convoluted tubules to block na+/Cl- symporter * 5-10% of sodium excretion e.g hydrochlorothiazide

Question 28

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

Answer 28

thiazides

Question 29

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

Answer 29

Furosemide

Question 30

Adverse effects of loop diuretics and thiazides

Answer 30

* Electrolyte imbalance * hypokalemia * can lead to arrhythymia * hyperuricemia(gout) * hypercholesterolemia * hyperglycemia

Question 31

Aldosterone receptor antagonist

Answer 31

* 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

Question 32

Spironolactone clinical uses

Answer 32

* 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

Question 33

Adverse effects of spironolactone

Answer 33

hyperkalemia

Question 34

new targets fro hypertnesion

Answer 34

inflammation, fibrosis, RAS, AT2