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Intro to Med > Treatment of hypertension > Flashcards

Treatment of hypertension Flashcards

1
Q

what happens if BP is too low?

A

Poor perfusion of tissues/end organs

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2
Q

What happens if BP is too high?

A

-Poor perfusion too (excessive vasoconstriction ‘shutting off’ flow)
-Excessive afterload (opposing ejection of blood from heart)
-Damage to blood vessels – part of plaque formation

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3
Q

What is the definition of hypertension?

A

Hypertension is defined according to increased risk 140/90 mmHg < 50 years
160/95 mmHg for older individuals

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4
Q

What is hypertension a strong risk factor for?

A

Hypertension is a strong risk factor for:
Stroke, Ischemic heart disease, Renal failure, Retinopathy, Left ventricular hypertrophy, Heart failure

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5
Q

What are possible causes of secondary hypertension?

A

Hormonal abnormalities, e.g., Conn’s syndrome (excess aldosterone),
Cushing’s syndrome (excessive mineralocorticoids), phaeochromocytoma
(excessive release of adrenaline from adrenal gland tumor)
Genetic conditions – e.g., Liddle’s Disease (Increased Na/H2O
reabsorption)
Renal diseases
Vascular causes, e.g., renal artery stenosis
Drugs - contraceptive pill
Pregnancy - pre-eclampsia

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6
Q

What are possible mechanisms that cause essential hypertension?

A

Increased sympathetic nervous system
Increased renin-angiotensin-aldosterone system (RAAS)
Obesity / Insulin resistance
Endothelial dysfunction
Defect in vascular smooth muscle contraction
Defects in renal Na handling, increased salt intake
Age
Ethnicity

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7
Q

Why do we treat essential hypertension?

A

Reduction in blood pressure level reduces relative risk of consequences

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8
Q

What are the 2 main treatment pathways for essential hypertension?

A

-Non-pharmacological, e.g., Life-style modifications
-Pharmacological treatment

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9
Q

What are examples of non-pharmacological treatment for essential hypertension?

A

Quit smoking – What help is available?
Weight control – Can you name high / low fat foods?
Eat less salt – Can you name high / low salt foods?
Regular exercise – How much is sufficient?
Reduce alcohol intake – What are the recommended levels?
Behavioural therapies – What is CBT?

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10
Q

What are major classes of antihypertensive drugs?

A

-RAAS modulation
-Calcium channel blockers
-Diuretics
-Drugs acting on sympathetic nervous system

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11
Q

What are examples of RAAS modulation drugs?

A

ACE inhibitors (ACEi, e.g., enalapril)
and
Angiotensin II receptor blockers (ARB, e.g., losartan)

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12
Q

What are examples of calcium channel blockers?

A

Dihydropyridines (e.g., amlopidine)

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13
Q

What are examples of diuretics?

A

Loop, thiazides, K-Sparring

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14
Q

What are examples of drugs acting on sympathetic nervous system?

A

Brain, Autonomic ganglia, 1- and 1-adrenoceptor blockers

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15
Q

What do ACEi do?

A

ACEi reduce production of Ang II

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16
Q

What do ARB act as?

A

ARB as competitive antagonists at AT1
receptors, reducing effects of Ang II

17
Q

What do both ACEi and ARB reduce and mediate?

A

Both drug types reduce Ang II-induced vasoconstriction and Ang II-mediated aldosterone actions

18
Q

What are the side effect of ACEi?

A

Angiotensin-converting enzyme also
breaks down bradykinin – which is a substance associated with
inflammation that stimulates sensory nerves
So ACEi will decrease bradykinin breakdown
Can cause dry cough - non-compliance issue
Due to raised bradykinin levels stimulating sensory nerves

19
Q

What is a very rare side effect of ACEi?

A

Causes angioedema (swelling under skin)
Often around lips
Can prevent breathing

20
Q

What can be done if the patient is non-compliant in taking ACEi due to a dry cough?

A

Can often change to anti-hypertensive drug

21
Q

What do calcium channel blockers do?

A

Voltage-dependent Ca2+ channel blockers
e.g., dihydropyridines (amlodipine)
Target VGCCs in Vascular smooth muscle cells
Vascular selective

22
Q

What does a reduction in calcium concentration lead to?

A

Reduction in [Ca]i in VSMCs
Less Ca-CaM-MLCK activity
-Increased relaxation
-Vasodilatation

23
Q

What are the side effects of Ca2+ channel blockers?

A

Increased heart rate – response to lowering BP
Headache/ankle swelling/flushing - excessive vasodilation

24
Q

What are contraindications of Ca channel blockers?

A

Heart failure, as drug reduces ability of heart to contract

25
Q

What do diuretics do?

A

These drugs increase
Na and H2O excretion from the kidneys

26
Q

How does a reduced blood volume reduce BP?

A

Reduce blood volume → reduces CO →
reduce BP (BP = CO x TPR)

27
Q

What effect does diuretics have on blood vessels?

A

Produces vasodilation

28
Q

What are examples of loop diuretics?

A

furosemide

29
Q

What are examples of thiazides?

A

Bendroflumethiazide

30
Q

What are examples of K-sparing drugs?

A

Spironolactone

31
Q

How does stimulation of beta 1 receptors in sympathetic nervous system increase BP?

A

Stimulate β1 – Increase HR and Contractility
→ Increase CO → Increase BP

32
Q

How does stimulation of alpha 1 receptors in sympathetic nervous system increase BP?

A

Stimulate α1 – Vasoconstriction →
Increase TPR → Increase BP

33
Q

What drugs decrease sympathethic activity through the CNS?

A

CNS : α2 adrenoceptor agonists, e.g., Clonidine (Hypertensive crisis)

34
Q

What are example of alpha 1 blockers and what do they do?

A

relaxation of vascular smooth muscle,
e.g., prazosin (hypertensive crisis, drug-resistance hypertension)

35
Q

What are examples of beta 1 blockers and what do they do?

A

reduction in CO and renin release, e.g., atenolol, bisoprolol

36
Q

What guidelines are used when choosing a drug?

A

NICE guidelines

37
Q

What is step 1, step 2 and step 3 in NICE guidelines for patients age<55 and not of black african or african-caribbean family origin?

A

Step 1:
-ACEi or ARB
Step 2:
-ACEi or ARB + Calcium channel blockers(CCB) or thiazide-like diuretic
Step 3:
-ACEi or ARB + CCB + thiazide-like diuretic

38
Q

What is step 1. step 2 and step 3 in NICE guidelines for patients age 55 or over, or black african or african-caribbean family origin(any age)?

A

Step 1:
-CCB
Step 2:
-CCB + ACei or ARB or thiazide like diuretic
Step 3:
-ACEi or ARB + CCB + thiazide-like diuretic

Intro to Med (46 decks)

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