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Physiology: Kidney > Treatment of hypertension > Flashcards

Treatment of hypertension Flashcards

1
Q

What is blood pressure?

A

The pressure exerted by blood on blood vessles

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2
Q

Short term regulation of blood pressure

A

Baroreceptors, Sympathetic and parasympathetic outflow

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3
Q

Long term regulation of blood pressure

A

Hormonal control of total body sodium

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4
Q

MABP

A

Mean Arterial Blood pressure

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5
Q

Equation for MABP

A

CO x TPR

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6
Q

Control of blood volume

A

Degree of vasoconstriction

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7
Q

Stage 1 hypertension

A

> /= 140/90

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8
Q

Stage 2 hypertension

A

> /=160/100

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9
Q

Stage 3 hypertension

A

> /= 180/110

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10
Q

What are the risk factors with hypertension

A
  • Stroke,
  • Ischemic heart disease
  • Left ventricular hypertrophy
  • Heart failure
  • Renal failure
  • Retinopathy
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11
Q

Secondary causes of hypertension

A

(<10%)
Renal disease
Vascular - e.g. renal artery stenosis
Hormonal- e.g. Conn’s syndrome, Cushing’s syndrome
Monogenic genetic diseases - e.g. Liddle’s

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12
Q

Primary causes of hypertension

A

(90%)

Genetic predisposition and environmental factors are proposed to cause essential hypertension through many mechanisms

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13
Q

Essential hypertension

A
  • Increased sympathetic nervous system
  • Increased renin-angiotensin-aldosterone system
  • Endothelial dysfunction
  • Defect in vascular smooth muscle contraction
  • Defects in renal Na handling increased salt intake
  • Obesity/ insulin resistance
  • Age (increases with age)
  • Ethnicity (e.g. more common in Afro-Caribbean groups)
  • Family history
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14
Q

Why treat hypertension?

A

reduce risk

  • reduce strokes by 42%
  • Reduce heart attacks by 16%
  • Reduce vascular mortality by 21%
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15
Q

Goals of anti-hypertensive treatment

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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16
Q

Treatment pathways

A

Nonpharmacological: lifestyle modifications
Pharmacological treatment
Surgical (e.g. Conn’s syndrome)

17
Q

Lifestyle

A
  • Quit smoking
  • Weight control
  • Eat less salt
  • Regular exercise
  • Reduce alcohol intake
  • Behavioral therapies, e.g. CBT
18
Q

Major classes of antihypertensive drugs

A 
ACE inhibitors
Angiotensin 2 receptor blockers
Diuretics
Drugs acting on Sympathetic Nervous system
Vasodilators
19
Q

ACE inhibitors and AT1 receptor blockers side effects

A
  • Cough (common) due to decrease in bradykinin breakdown

- Angioedema (rare but serious)

20
Q

Side effects of both ACEi and ARBs

A

Hyperkalaemia - so cardiac issues

21
Q

Diuretics

A

Increase in sodium and water excretion

Reduce blood volume - reduces CO - reduce BP

22
Q

Sympathetic neural effects on CVS

A

Beta 1 - increase HR and contractility- increase CO and increase BP
Alpha 1- vasoconstriction - TPR- increase BP

23
Q

Beta-blockers

A

Reduction in CO and renin release

24
Q

Vasodilators (hint k channels)

A

Are K channel openers - Arterioles normally have significant smooth muscle tone - scope for relaxation

25
Q

How do Vasodilators work?

A
  • Increase outward K current
  • Hyperpolarization
  • Reduced VGCC activity
  • Reduced [Ca] intracellular
  • Less MLCK activity - increased relaxation (vasodilation)
  • e.g. Minoxidil, Diazoxide
26
Q

Vasodilators VGCC blockers

A

Voltage-dependent Ca2+ channel blockers
Block VGCC activity in Vascular smooth muscle cells
Reduced [Ca] i
Less MLCK activity - increased relaxation (vasodilators)

27
Q

Key issues to consider whilst picking drugs

A 
Essential vs Secondary hyepertension
Evidence of efficacy
Side effects of drug
Drug interactions
Individual demographics
Co-existing diseases
Quality of life
Economic considerations
28
Q

What are the guidelines for drug use

A

NICE (National Institute for Health and Clinical Excellence)

Physiology: Kidney (14 decks)

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