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Kidneys and Renal functions > Treatment of Hypertension > Flashcards

Treatment of Hypertension Flashcards

1
Q

How do we calculate BP?

A

BP = CO x TPR

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2
Q

What is the significance of BP?

A

Important for organ perfusion

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3
Q

How would we calculate blood flow?

A

Flow = Art. BP / TPR

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4
Q

What is blood pressure?

A

Pressure exerted by blood on blood vessels

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5
Q

What are the short term controls of BP?

A

Baroreceptors (neural systems)

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6
Q

What is the long term control of BP?

A

Vasoconstriction and ECFV

hormonal Na balance

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7
Q

What are the causes of High BP?

A

Increase in ECFV
Increase in vasoconstrictor agents
Reduction in vasodilator agents

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8
Q

How is hypertension defined as?

A

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

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9
Q

What is hypertension a strong risk factor for?

A 
Stroke
Ischemic heart disease 
Renal failure
Retinopathy
Left ventricular hypertrophy
Heart failure
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10
Q

What are the causes of secondary hypertension?

A

10 % of cases - Identifiable causes:

Renal diseases
- e.g. glomerulonephritis, diabetic nephropathy

Vascular causes
- e.g. renal artery stenosis

Hormonal abnormalities
- e.g. Conn’s syndrome, Cushing’s syndrome,
phaechromocytoma

Drugs
- contraceptive pill

Pregnancy
- pre-eclampsia

Monogenic genetic diseases
– Liddle’s syndrome

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11
Q

What are the causes of primary hypertension?

A

90% of cases
due to unknown cause
Prevalence in urban-based populations ~ 20%

Genetic pre-disposition and environmental factors thought to cause essential hypertension

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12
Q

What mechanisms are involved in essential hypertension?

A

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

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13
Q

What is the significance of treating hypertension?

A 
Reduction in blood pressure level reduces relative risk of consequences 
5 mmHg drop in diastolic BP for 5 yrs
Reduce strokes by 42%
Reduce heart attacks by 16%
Reduce vascular mortality by 21%
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14
Q

What are the aims of anti-hypertensive treatments?

A

Adequate blood pressure control - < 140/90 mmHg, alter relative risk
Prevention of target organ damage
Controlling other cardiovascular risk factors

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15
Q

What are the 3 main treatment pathways for hypertension?

A
  1. Non-pharmacological, e.g. Life-style modifications
  2. Pharmacological treatment
  3. Surgical, e.g. Conn’s syndrome
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16
Q

What non-pharmacological treatments are there?

A 
Lifestyle changes:
Quit smoking 
Weight control 
Eat less salt 
Regular exercise 
Reduce alcohol intake 
Behavioural therapies
17
Q

What are the major classes of anti-hypertensive drugs?

A 
ACE inhibitors
Angiotensin II receptor blockers
Diuretics
Drugs acting on Sympathetic Nervous System
Vasodilators
18
Q

How do ACE inhibitors (e.g. enalapril) and AT1 receptor blockers (iosartan) decrease BP?

A

ACE inhibitors prevent the converison of Ag I → Ag II

AT II antagonists block AT1 receptors to stop Ag II binding

  • less vasoconstriction
  • less aldosterone secretion
19
Q

What are the effects of ACE inhibitors and AT1 antagonists?

A

decrease in vasoconstriction and aldosterone actions to reduce blood pressure

20
Q

what are the side effects of ACEi?

A

Caused by ↓ Ang II effects
Cough (common) - ↓ bradykinin breakdown (non-compliance issue)
Angioedema (rare) - ↓ bradykinin breakdown (very serious, prevent breathing)
can cause fetal problems if taken during pregnancy

21
Q

What are the side effects of ACEi/ARBs?

A

Hyperkalaemia
(Opposite to loop and thiazide diuretics)
Due to ↓ aldosterone, ↓ Na reabsorption and hence ↓ K excretion

22
Q

How does renal stenosis affect ACEi?

A

↓ efferent renal arteriole constriction

↓ pressure gradient across bowman’s capsule → ↓ GFR

23
Q

What is the effect of diuretics?

A

Increase in sodium and water excretion

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

24
Q

Name examples of diuretics

A

Loop diuretics
Thiazides
Potassium-sparing

25
Q

What are the major side effects of diuretics?

A

Hypokalaemia (Loop and thiazide diuretics but not K sparing diuretics)
Lipid abnormalities
Glucose intolerance/hyperglycemia
- ↓ insulin release

26
Q

How does sympathetic nerves stimulation of CVS affect BP?

A

β1 – increase HR + contractility → increase CO → increase BP

α1 – vasoconstriction → TRP → increase BP

27
Q

How can we decrease sympathetic activity?

A

CNS : α2 adrenoceptor agonists, e.g. Clonidine (Hypertensive crisis)
Ganglion blockers : NIC blockers, e.g. Trimethapan (hypertensive crisis)
Synaptic blockade : e.g. reserpine (old anti-hypertensive)

28
Q

What adrenoceptor blockers are used for hypertension?

A

α1 blockers : relaxation of vascular smooth muscle,
e.g. prazosin (hypertensive crisis)
β1 blockers : reduction in CO and renin release, e.g. atenolol

29
Q

What vasodilators do we use to treat hypertension?

A

K channel openers

Ca2+ channel blockers

30
Q

Give examples of K+ channel openers

A

e.g. Minoxidil, Diazoxide

31
Q

Explain the mechansim of action of K channel openers

A
  1. K channels open, K efflux
  2. Vascular smooth muscle hyperpolarization
  3. Reduction in voltage-gated Ca channel activity
  4. Reduction in [Ca]i
  5. Less MLCK activity → Increased relaxation →
    vasodilatation
32
Q

What Ca2+ channel blockers are there?

A

Voltage-dependent Ca2+ channel blockers
e.g. dihydropyridines (amlodipine)
More vascular selective

33
Q

How do Ca2+ channel blockers work?

A
  1. Block voltage-gated Ca channel activity in VSMCs
  2. Reduction in [Ca]i
  3. Less MLCK activity → Increased relaxation →
    Vasodilatation
34
Q

What issues are to be taken into consideration in selecting drug therapy?

A 
Essential vs. secondary hypertension
Evidence of efficacy
Side effects of drug
Drug interactions
Individual demographics
Co-existing diseases
Quality of life
Economic considerations
35
Q

What is NICE?

A

NICE – National Institute for Health and Clinical Excellence

Kidneys and Renal functions (14 decks)

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