Week 5 -hypertension Flashcards
Epidemiology of hypertension
One of the major risk factors for CVD
Prevalence increase with age
Some medications can increase BP
Hypertension pathophysiology
Conditions where the force of blood against the walls of your arteries is consistently too high
Involves
1. Artesia, constriction
2. Increased blood volume
3. Overactive SNS
4. RAAS
5. Endothelial dysfunction
Consequences of untreated hypertension
MI, angina, heart failure
Stroke, cerebral haemorrhage
Renal failure
Peripheral vascular disease
Treatment -initiating drug therapy MODERATE
Initiate anti hypertensive drug treatment immediately in hypertension patients c,assigned as having moderate risk of CVD event in next 5 years with any of the follows
- be >= 160/100 mmHg
- fam history of premature CVD
Indigenous descent
Treatment-initiation drug therapy - high
Initiate immediately patients classified as high risk of CVD event in next 5 years
Ace inhibitors
Block conversion of angiotensin I to angiotensin II
- Decrease all-induced vasoconstriction
- Decrease arterial pressure
- Decrease aldosterone which decrease sodium and fluid retention
Ace indications
Hypertension
Chronic heart failure with decreased ejection fraction
Diabetic nphropathy
Prevention of progressive renal failure in persistent proteinuria
Post myocardial infarction
Ace inhibitors contraindications/cautions
Pregnancy
Renal impairment
Geriatric
K+ increasing drugs/NSAIDS/diuretics/anaesthetics
Black people may be less effective
ACE inhibitors adverse effects
Common: hypotension, cough, hyperkalaemia, headache, dizziness, fatigue, nausea and renal impairment
When starting ACE Inhibitors
Stop K+ supplements and K+ sparing diuretics
Stop other diuretics/review use of NSAIDs
Start with a low dose
Angiotensin II receptor antagonist/blockers
Competitively blocks binding of angiotensin II to type 1 angiotensin receptors
Decrease all-induced vasoconstriction
Decreased aldosterone which decrease sodium and fluid retention
ARBs/Sartans
Contraindications/precautions are same as ACE-I
Adverse effects similar to ACE-I is less frequent and cough is far
Max hypertensive effect may occur 4-6 weeks after starting treatment
If response to low-dose spartan is inadequate then it is more effective to add a second agent
Calcium channel blockers (CCBs)
Block inward current of calcium in vascular smooth muscle, myocardium and cardiac conduction system
Decrease vascular resistance in arterolar smooth muscle
Thiazide diuretics
Indications:
Mild to moderate hypertension
Oedema associated with heart failure or hepatic cirrhosis
Nephrogenic diabetes insipidus
Adverse effects
Common: dizziness, weakness, muscle cramps, polyuriz, or tho static hypotensinsion, low sodium, potassium, magnesium
Effects on glucose tolerance, lips and male sexual factors are low doses
Thiazide diuretics contraindications/cautions
Pregnancy
Hepatic impairment
Geriatric
NSAIDSs
Renal
