Systemic Hypertension Flashcards
Formula for BP
CO X PVR
Formular for CO
HR X SV
What are the three types of systemic hypertension?
White coat
Primary
Secondary
What are the differentials for Secondary hypertension?
Renal Disease
Adrenocortical disease
Diabetes mellitus
Hyperthyroidism
Pheochromocytoma
Polycythemia
Acromegaly
Iatrogenic
Diet & Breed (sigh hounds)?
What drugs are associated with secondary systemic hypertension?
corticosteroids
phenylpropranolamine
cyclosporin A
Erythropoietin
NSAIDS
Electrolyte solutions
Adrenergic agonists
What three elements can be changed to result in systemic hypertension?
PVR, HR, SV
What is the most common cause of systemic hypertension?
renal disease
A dog presents with systemic hypertension and a left-sided murmur. Explain the pathophysiology of the murmur?
concentric hypertrophy of the left ventricle d/t pressure overload which leads to increase wall stiffness & reduced diastolic filling
What organs are most commonly affected by systemic hypertension?
CV
Renal
Ocular
CNS
When using a doppler to read BP, what is being measured?
systolic pressure
If you want to perform an indirect BP reading in a cat, which method is most accurate?
Doppler
A BP > than ____ would warrant further dx & tx.
160/100 mmHg
Which breed of dog typically has BP measures 10-20 mmHg higher than other breeds?
sighthounds
List the BP values for the different severities of systemic hypertension.
Minimal risk BP<150/95
Mild risk BP= 150-159/95-99
Moderate risk BP= 160-179/100-119
Severe risk BP>180/120
At which risk level are anti-hypertensive medications recommended?
Moderate risk BP= 160-179/100-119
An owner asks you about using salt restriction for BP control in her cat. What are your recommendations?
Salt restriction is not recommended as it can activate the RAAS to increase peripheral vascular resistance which will worsen the CV & renal consequences
What are the adverse effects of using ACEi?
Decreased GFR & azotemia
Hyperkalemia
You place a cat with renal insufficiency and proteinuria on an ACEi. How soon after should the renal values be checked?
5-7 days
Why are ACEi typically combined with Ca channel blockers?
the vasodilation caused by the decreased Ca influx into the vascular smooth muscle may activate the RAAS.
Which antihypertensive is the first line drug used in cats?
amlodipine
In addition to serving as an anti-hypertensive, what other effects does Diltiazem have on the CV system?
decreased HR & contractility (decr. CO)
Why is amlodipine often combined with Acei?
Amlodipine causes preferential vasodilation of afferent renal arterioles & increased intraglomerular pressure –> promotes glomerular damage
ACEi are renoprotective (reduce glomerular pressure and proteinuria)
What is the treatment of choice for hypertension d/t hyperthyroidism?
B-blocker
Which B-blockers (esmolol, atenolol, propranolol) are nonspecific vs. cardioselective?
Propranolol- nonspecific
esmolol (short acting), atenolol- cardioselective
What is the treatment of choice for pheochromocytomas?
a1 blockers- peripheral vasoddilation
(phenoxybenzamine & prazosin)
Which drug causes direct vasodilation by an unknown mechanism with a rapid onset of action?
Hydralazine
What is the adverse effect of nitroprusside that may occur with high doses or prolonged treatment?
cyanide toxicity
What diuretic may be indicated in cases of hyperaldosteronism?
Spironolactone
When would administration of diuretics (furosemide & hydrochlorothiazide) be contraindicated?
chronic renal disease & dehydration
How closely should you monitor BP after a dose adjustment? Once BP is controlled?
7-10 days
q1-4 months (start w/ shorter interval & increase)
