Treatment of Hypertension

Question 1

What are the 6 points important in diagnosing and treating Hypertension?

Answer 1

1) Screening those at risk
2) Increasing public awareness of the risk factors
3) Reliable diagnosis based on clinical guideliness
4) Promote lifestyle changes to limit risks
5) Regular monitoring and changing medication if necessary
6) Compliance with medication and lifestyle changes

Question 2

What is the ABPM and how should it be used?

Answer 2

Ambulatory Blood Pressure Monitoring (ABPM) is when your blood pressure is being measured as you move around, living your normal daily life. It is normally carried over 24 hours.

Question 3

What is the HBPM and how should this be used?

Answer 3

These are normally undertaken for 7 days unless told otherwise. Readings should be taken twice a day, one in the morning and one in the evening. A minimum of two readings must be taken at each time with at least a minute gap between each reading. If there is a large difference in the two readings, take another two for more accuracy.

Question 4

ACE inhibitors: what do they do? (2)

Answer 4

These prevent the ACE enzyme from converting Angiotensin I to Angiotensin II.
Prevent the breakdown of Bradykinin (a vasodilator) increasing vasodilation

Question 5

Reduced levels of Angiotensin II results in:

Answer 5

Vasodilation, Reduced Aldosterone production, Reduced ADH, and reduced cell growth and proliferation.

Question 6

Why DOESN’T the ACE inhibitor prevent all the Angiotensin II from being produced?

Answer 6

Because some Angiotensin II is produced independantly from the ACE via the chymase interaction therefore even in the precense of ACE inhibitor, there is still some Angiotensin II being produced.

Question 7

What is the well known side effect of ACE inhibitors?

Answer 7

A persistent dry cough - not soothed by cough medicines..

Question 8

What are ARBs?

Answer 8

Angiotensin II receptor blockers

Question 9

How do ARBs work?

Answer 9

These work by blocking AT1 receptors and therefore inhibiting Angiotensin II from binding.

Question 10

What are the differences between ARBs and ACE inhibitors?

Answer 10

ARBs have no effect on Bradykinin, they have no associated dry cough, and ARBs are also more effectine at targeting Angiotensin II production via the chymase interation.

Question 11

Give examples of ARBs

Answer 11

Losartan, Candesartan

Question 12

Give examples of ACE inhibitors:

Answer 12

Perdinolpril, Lisinopril and Ramipril

Question 13

What are the three types of Calcium Channel Blockers and why are they different to each other?

Answer 13

These interact with different alpha subunits on the Voltage-Operated-Calcium-Channel.

• Dihydropyridines
• Phenylalkylamines
• Benzothiapines

Question 14

What is the mechanism of action of CCB?

Answer 14

They prevent the influx of calcium into cells, thereofre reducing the Calcium initiated smooth muscle contration. This redicution in contraction is an anti-hypertensive effect.

Question 15

Where are the VOCC expressed in the body?

Answer 15

These are expressed throughout the body on vascular smooth muscle cells, and they are also expressed in cardiac tissue.

Question 16

Describe the Dihydropyridines CCB: and give examples

Answer 16

These are more selective for the peripheral vasculature (targer vasculature not in the chest or abdomen) by targeting vascular beds and causing periperal vasodilation.
They show liitle or no chronotropic effects or inotropic effects. Nifedipine, Amlodipine, Felodipine

Question 17

Describe the Phenylalkylamine CCB:

Answer 17

(Non-dihydropyridine) These are more selective for cardiac tissue so show more chronotropic and iontorpic effects. They are not used often for HYpertension, more for other CV diseases.
e.g. Verapamil

Question 18

Describe the Benzothiapine CCB:

Answer 18

These have some selectivity for cardiac tissue but not as much as the phenylalkylamines. They also have some effect on the vasculature.
e.g. Diltiazem

Question 19

Diuretics: What are these?

Answer 19

These are the 3rd major class of Hypertensives that work to increase urine volume. the main mechanism of action is inhibiting Na reabsorbtion in the nephron. Water follows sodium, so also stays in the nephron, increasing the amount of urine produced resulting in lower blood pressure and extracellular volume.

Question 20

WHat are the different types of Diuretic drugs? and which are used for hypertension?

Answer 20

Loop Diuretics, Thiazide and Thiazide-like drugs

For hypertension, normally as a second or third step, Thiazide-like drugs are used like Indapimide.

Question 21

Beta-Blockers. How do these work?

Answer 21

Work by decreasing the sympathetic tone by blocking Noradrenaline and reducing myocardial contraction. This results in reduced cardiac output and as a by-product, reduced renin (so less Ang II and it’s effects)

Question 22

WHat is the disadvantage of B-blockers?

Answer 22

Can cause Bronchial vasoconstriction (some more selective than others) which isn’t good in asthmatics, COPDs or 2nd/3rd degree heart block patients.
They may also mask tachycardia which is a sighn of insulin induced hypoglycaemia in diabetics.

Question 23

Why aren’t Beta blockers primary treatment any more?

Answer 23

They are less effective at reducing Morbidity and Mortality rates.