Therapeutics of HTN Flashcards
ACEi role in which diseases
HF, HTN, nephropathy, post MI, post stroke, high CV risk
ACEi mechnisms
Remodelling of heart and vasculature
Endothelial function and BP
2 main side effects of ACEi
HYPOTENSION
Functional renal impairment -
side effects of ACEi
Hypotension Functional renal impairment Hyperkalaemia - with other drugs Cough - accumulation of bradykinin Angioneurotic oedema Fetal abnormalities if used in pregnancy
ACEi effect on renal function
AngII constricts efferent arteriole to maintain glomerular pressure
ACEi = decreased GFR by 10-15%
Dramatic in renal stenosis
Why do we need ARB?
ACE-I do not completely stop AngI release and their side effects can be a problem
Name ARB
- sartans
Side effects of ARB
Relatively side effect free
Much lower risk of cough and agioneurotic oedema Although not quite 0
Compensatory increase in bradykinin synthesis leading to cough, but it is less of an issue with ARBs
Efficacy dose relationship ARB
Efficacy related to dose (increased dose, increase efficacy)
Using combination or ACEi and ARB?
NEVER
Side effects worse - hypokalaemia
Benefits of ARB
- lower BP
- renal antiproteinuric effects
- HF benefit
Comparison of 2 aldosterone antagonists
Spironalactone
-limited by effects on other steroid receptors: Gynecomastia or breast pain
Impotence, menstrual irregularity
Eplerenone
- less effective but more specific
- fewer adverse effects
What is resistant HTN
Most cases occur because people don’t take tablets but 5% genuinely resistant, whose BP doesn’t go down even with right drugs.
In these patients spironalactone is V effective
Types of CCB
Dihydropyridines (mainly vasodilators)
↘ Nifedipine, amlodipine, lacidipine, nimodipine
Non-dihydropyridines (also affect cardiac function - contractility and conduction):
↘ Phenylalkylamines (verapamil)
↘ Benzothiazepines (diltiazem)
Side effects of CCB
Side effects not really very dangerous
Strong advantage, no complete contraindications Inconvenient side effects but not dangerous
