Treatment of Hypertension

Question 1

What is blood pressure?

Answer 1

→ Pressure exerted by blood on blood vessels

Question 2

What does short term regulation of blood pressure involve?

Answer 2

→ baroreceptors

→ Sympathetic and parasympathetic outflow

Question 3

What does long term regulation of blood pressure involve?

Answer 3

→ Hormonal control of total body Na+
→ Control of blood volume via ECFV
→ Degree of vasoconstriction

Question 4

What is the criteria for hypertension?

Answer 4

→ 140/90 mmHg

Question 5

What is hypertension a risk factor for?

Answer 5

→ Stroke
→ Ischaemic heart disease
→ Left ventricular hypertrophy and heart failure
→ renal failure
→ retinopathy

Question 6

What are secondary causes of hypertension?

Answer 6

→ Renal
→ Vascular - renal artery stenosis
→ Hormonal - Conns, Cushings
→ Monogenic genetic diseases - Liddles

Question 7

What is a primary cause of hypertension?

Answer 7

→ Genetic pre disposition and environmental factors

Question 8

What are 3 possible mechanisms for essential hypertension?

Answer 8

→ Increased sympathetic nervous system
→ Increased RAAS
→ endothelial dysfunction

Question 9

What are 2 possible defects in essential hypertension?

Answer 9

→ Vascular smooth muscle contraction

→ Na+ handling and excessive salt intake

Question 10

What are 4 risk factors for essential hypertension?

Answer 10

→ Obesity
→ Age
→ Ethnicity
→ Family history

Question 11

What does the treatment of hypertension reduce the risk of and by how much?

Answer 11

→ Strokes by 42%
→ Heart attacks by 16%
→ Vascular mortality by 21%

Question 12

What are the goals of anti-hypertensive treatment?

Answer 12

→ Adequate blood pressure control
→ Prevention of target organ damage
→ Controlling other cardiovascular risk factors

Question 13

What are the treatment pathways for hypertension?

Answer 13

→ Non-pharmacological
→ Pharmacological treatment
→ Surgical

Question 14

What are 6 lifestyle changes to prevent hypertension?

Answer 14

→ Quit smoking
→ Weight control
→ Eating less salt
→ Regular exercise
→ Reduce alcohol intake
→ Behavioral therapy

Question 15

What are 5 major classes of anti hypertensive drugs?

Answer 15

→ ACE inhibitors
→ Angiotensin II receptor blockers
→ Diuretics
→ Drugs acting on sympathetic nervous system
→ Vasodilators

Question 16

What are 3 side effects from ACE inhibitors?

Answer 16

→ Cough - due to decrease in bradykinin breakdown responsible for inflammation
→ Angioedema
→ Hyperkalaemia

Question 17

What do diuretics do?

Answer 17

→ Increase in Na+ and water excretion
→ Reduce blood volume
→ reduce BP and CO

Question 18

Why do ACE inhibitors causes hyperkalaemia?

Answer 18

→ Reduced aldosterone
→ Decreased Na+ reabsorption
→ Decreased K+ excretion

Question 19

What do Beta 1 receptors do?

Answer 19

→ Increase HR and contractilityn
→ Increase CO
→ Increase BP

Question 20

What do alpha 1 receptors do?

Answer 20

→ vasoconstriction
→ TPR
→ Increased BP

Question 21

What do alpha 2 receptors do?

Answer 21

vasodilation

Question 22

What do beta blockers cause?

Answer 22

→ Reduction in CO and renin release

Question 23

How do K+ channel openers work?

Answer 23

→ K+ channels open
→ K+ efflux
→ Hyperpolarization
→ Reduced VGCC activity
→ Reduced intracellular Ca2+
→ Less MLCK activity + increased relaxation

Question 24

How do Ca2+ channel blockers work?

Answer 24

→ Block VGCC activity in smooth muscle cells
→ reduced intra cellular Ca2+
→ Less MLCK activity + increased relaxatio

Question 25

What are issues to take into consideration when treating hypertension?

Answer 25

→ Evidence of efficacy
→ Side effects
→ Drug interactions
→ Quality of life
→ economic considerations

Question 26

What are stages of hypertension?

Answer 26

Stage 1 hypertension ≥ 140/90
Stage 2 hypertension ≥ 160/100
Severe hypertension ≥ 180/110

Question 27

Why treat hypertension?

Answer 27

Reduce strokes by 42%
Reduce heart attacks by 16%
Reduce vascular mortality by 21%