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A: HYPERTENSION Flashcards

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1
Q

Blood pressure is elevated enough to perfuse tissues and organs

A

Hypertension

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2
Q

High blood pressure

A

Hypertension

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3
Q

It is not a disease but an important risk factor for cardiovascular complications

A

Hypertension

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4
Q

It can be defined as a condition where blood pressure is elevated to an extent where clinical benefit is obtained from blood pressure

A

Hypertension

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5
Q

What are the Classification of Hypertension

A

Normal: < 120mmHg Systolic and < 80mmHg Diastolic

Pre hypertension or Elevated: 120-139 mmHg Systolic and 80-89mmHg Diastolic

HBP/HTN Stage 1: 140-159mmHg Systolic or 90-99mmHg Diastolic

HBP/HTN Stage 2: Greater than 160mmHg Systolic or Greater than 100mmgHg Diastolic

HTN Crisis: >180 mmHg or >120 mmHg

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6
Q

Blood Pressure Categories:
Normal

A

< 120mmHg Systolic and < 80mmHg Diastolic

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7
Q

Blood Pressure Categories:
Pre hypertension or Elevated

A

P120-139 mmHg Systolic and 80-89mmHg Diastolic

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8
Q

Blood Pressure Categories:
HBP/HTN Stage 1

A

140-159mmHg Systolic or 90-99mmHg Diastolic

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9
Q

Blood Pressure Categories:
HBP/HTN Stage 2

A

Greater than 160mmHg Systolic or Greater than 100mmgHg Diastolic

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10
Q

Blood Pressure Categories:
HTN Crisis

A

> 180 mmHg or >120 mmHg

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11
Q

Types, Causes, or Incidence of Hypertension

A

Primary Hypertension / Essential
Secondary Hypertension

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12
Q

No specific cause of Hypertension

A

Primary Hypertension / Essential

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13
Q

Identifiable cause

A

Secondary Hypertension

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14
Q

Physiology, or Formula of BP or HTN

A

BP = CO ✕ TPR

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15
Q

CO stands for

A

Cardiac Output

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16
Q

TPR stands for

A

Total Peripheral Resistance

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17
Q

Formula of CO

A

SV x HR

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18
Q

SV stands for

A

Stroke Volume

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19
Q

HR stands for

A

Heart Rate

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20
Q

Complications of HTN

A

1.) Cardiac Effects
a.) Left ventricular Hypertrophy
b.) Accelerated Atherosclerosis
2.) Renal Effects
3.) Cerebral Effects
4.) Retinal Effects

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21
Q

Blood pressure is measured using a

A

Sphygmomanometer

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22
Q

A device composed of an inflatable cuff to restrict the blood flow, and a mercury or mechanical manometer to measure the pressure

A

Sphygmomanometer

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23
Q

Blood Pressure is measured by

A

Sphygmomanometer
Manual (Mercury & Aneroid)
Digital

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24
Q

What is a present symptom in HTN

A

Headache

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25
It is usually unclear if this is caused by hypertension or is an incidental finding
Headache
26
Predisposing Factors
- Family history - Patient history - Racial predisposition - Obesity - Smoking - Stress - Sedentary lifestyle - Intake of fats and salts
27
Patient’s history and other physical findings suggest an underlying cause of hypertension
Secondary Hypertension
28
Diseases or Disorders that can cause High Blood Pressure
Primary aldosteronism Pheochromocytoma Renal artery stenosis
29
It is a clinical situation in which blood pressure is very high with minimal or no symptoms, and NO signs or symptoms indicating acute organ damage
Hypertensive urgency
30
Hypertensive emergency is also known as
Malignant hypertension or accelerated
31
A high blood pressure with potentially life-threatening symptoms and signs indicative of acute impairment of one or more organ systems
Hypertensive emergency
32
Diagnosis: Home or ambulatory blood pressure measurements is recommended to prevent
“white coat hypertension”
33
It is recommended to prevent “white coat hypertension”
Home or ambulatory blood pressure measurements
34
The number of times the heart beats in one minute
Cardiac Output
35
Diagnostics
CBC Lipid Profile (HDL, LDL, Triglycerides) SGOT SGPT Na K Ca BUN BUA FBS & RBS CREA HBA1C Urinalysis
36
What are the Lipid Profile
HDL, LDL, and Triglycerides
37
What are the electrolytes needed in Diagnostic
Na, K, and Ca
38
General Principle for the treatment of HTN
To lower blood pressure toward NORMAL with minimal side effects and to prevent or reverse organ damage
39
Candidates for the treatment of HTN
Patients with diastolic >90mmhg and systolic of >140mmhg
40
Non- specific measures / Non- Pharmacologic measures
* Weight loss results in reduction in BP of about 2.5/1.5 mmHg per kg (for overweight patients) * Reduce salt intake (aim is <100 mmol daily sodium intake) * Diet high in fruit and vegetables, legumes and whole grain cereal improves cardiovascular risk * Regular dynamic exercise for at least 30 minutes on most days * Alcohol intake should be restricted * Quit smoking
41
Non-Pharmacologic Approaches: Weight loss results in reduction in BP of about __ (for overweight patients)
2.5/1.5 mmHg per kg
42
Non-Pharmacologic Approaches: Diet high in fruit and vegetables, legumes and whole grain cereal improves __
Cardiovascular risk
43
Non-Pharmacologic Approaches: Reduce salt intake (aim is __ daily sodium intake)
<100 mmol
44
Non-Pharmacologic Approaches: Regular dynamic exercise for at least __ on most days
30 minutes
45
AB/CD Algorithm by
Williams et al 2004
46
Initial choice of ACE inhibitor or angiotensin receptor blocker and β blocker as first line therapy in younger nonblack patients (<55 years)
Treatment A/B
47
Said patients often have hypertension associated with high concentration of renin. It is therefore logical to treat them with drugs that antagonize the renin-angiotensin system
Treatment A/B
48
In treatment A/B the initial choice as first line therapy are
ACE inhibitor or angiotensin receptor blocker and β blocker
49
Treatment A/B is suitable for
younger nonblack patients (<55 years)
50
For elderly and black patients, who tend to have hypertension associated with low renin concentration, calcium channel blockers and thiazide diuretics are recommended
Treatment C/D
51
What is the recommended medicine in the treatment C/D
calcium channel blockers and thiazide diuretics
52
Treatment C/D is suitable for
elderly and black patients
53
What happens if initial drug therapy fails
A or B is combined with C or D
54
MOA: inhibition of the conversion of angiotensin 1 to angiotensin 2
Ace Inhibitors
55
Ace Inhibitors example
Captopril Enalapril (enalaprilat) Fosinopril Lisinopril Dolapril Perindopril
56
MOA: works by blocking the binding of Angiotensin 2 to the receptor
Angiotensin Receptor Blockers
57
ARBS stands for
Angiotensin Receptor Blockers
58
ACE inhibitors stands for
Angiotensin-converting enzyme
59
Angiotensin Receptor Blockers example
Telmisartan Losartan Olmesartan Valsartan
60
MOA: Blocks Beta adrenergic system
Beta Blockers
61
Whites with high cardiac output, high heart rate and normal vascular resistance respond the best with
Beta Blockers
62
In Beta Blockers the stimulation of renin secretion is
blocked
63
In Beta Blockers the cardiac contractility is
decreased
64
In Beta Blockers the reduction in heart rate
decreases cardiac output
64
In Beta Blockers the sympathetic output is
decreased
65
Beta blockers must be used cautiously in patients with
DM, Reynaud’s syndrome, & Neurological Disorder
66
NO beta blocker is safe with patients with
bronchospastic problem
67
What are the Beta-1 Selective Beta blockers
Metoprolol Atenolol Acebutolol Esmolol Betaxolol Nebivolol
68
First B1 selective
Metoprolol
69
Have high intrinsic activity
Acebutolol
70
Shortest T1/2 (Half-life)
Esmolol
71
What are Non-Selective Beta blockers
Propranolol Nadolol Timolol Pindolol Penbutolol Carvedilol ( with alpha blocking property)
72
Effective after Acute MI to prevent sudden death
Timolol
73
1st adrenergic to have high intrinsic activity
Pindolol
74
Significant Interaction in CCB
Beta blocker + Calcium Channel Blocker
75
MOA: Inhibits influx of calcium through slow channels in vascular smooth muscle and cause relaxation
Calcium Channel Blocker
76
These agents must be used with extreme caution or not at all in patient with conductive disturbances involving SA and AV node
Non-Dihydropyridine
77
Non-Dihydropyridine example
Verapamil Diltiazem
78
Dihydropyridine example
Nifedipine Amlodipine Clevidipine Isradipine Felodipine Nicardipine (2ND GENERATION )
79
To produce more selective effects on specific target tissues than the first generation agents
Dihydropyridine
80
Blocks the peripheral postsynaptic Alpha-1 adrenergic receptor
Peripheral Alpha-1 Adrenergic Antagonist
81
Given to HTN patients who have not responded to initial HTN therapy
Peripheral Alpha-1 Adrenergic Antagonist
82
Peripheral Alpha-1 Adrenergic Antagonist
terazosin prazosin doxazosin
83
Side effect of Zosin
may cause 1st dose phenomenon
84
MOA: act primarily within the CNS on alpha 2 receptors to decrease sympathetic outflow to the cardiovascular system
Centrally Active Alpha Agonist
85
Centrally Active Alpha Agonist Example
Methyldopa Clonidine Guanabenz Guanfacine
86
Decrease TPR and CO
Methyldopa
87
Acts centrally , as well as peripherally, by depleting catecholamine stores in the brain and in the peripheral adrenergic system
Reserpine
88
Given in low doses to treat refractory hypertension
Reserpine
89
Contraindicated to patients with history of depression
Reserpine
90
usual dose of Reserpine
0.1 to 0.25 mg per day
91
Second line agents in patients with refractory to initial therapy
Vasodilators
92
First line agents in patients with refractory to initial therapy
Reserpine
93
MOA: directly inhibits renin = reduction of production of Angiotensin 2
Aliskiren (Renin Inhibitor)
94
Vasodilators example
Hydralazine Minoxidil Nitroprusside
95
Arteriole relaxation & decrease of systemic vascular resistance
Hydralazine
96
decreases peripheral resistance
Minoxidil
97
releases nitric oxide
Nitroprusside
98
What forms in the blood vessel that causes HBP
Plaque

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